Fewer Kentuckians enrolled in federally subsidized health plans for 2023, likely because many of them could remain on Medicaid

By Melissa Patrick

Kentucky Health News

Fewer Kentuckians signed up for a government-subsidized health plan on Kynect, the state-based marketplace, in 2023 than in the previous two years, likely because more of them qualified for Medicaid during the pandemic and were still covered by it. 

The final Centers for Medicare & Medicaid Services 2023 open enrollment report shows 62,562 Kentuckians signed up for health insurance on Kynect through Jan. 15, which was the last day to enroll.  That's a 15% drop from 73,935 in 2022 and a 19% drop from 77,821 in 2021, according to last year's report. 

"Our best guess is that more Kentuckians are currently covered by Medicaid right now because of the continuous-eligibility provision that's been in place during the pandemic," Emily Beauregard, executive director at Kentucky Voices for Health, said in an email. "When renewals begin this spring, we expect some Kentuckians enrolled in Medicaid to move" to a private but federally subsidized Qualified Health Plan. 

Beauregard referred to the end of a federal program that kept people continuously enrolled on Medicaid during the pandemic without the need to re-enroll and certify their incomes to qualify. This program will end March 31, under an end-of-year omnibus law that requires Medicaid agencies to restart their annual renewal process. This process has been dubbed "Medicaid unwinding." 

At a Jan. 12 state Senate and House Joint Health Services Committee meeting, Veronica Judy-Cecil, senior deputy commissioner of the state Department for Medicaid Services, gave a snapshot of how many Kentuckians this will affect.

She said the state estimates that of the 1.7 million Kentuckians on Medicaid, 243,368, about 14%, will lose eligibility during the unwinding. Slides presented at Beshear's Feb. 2 news conference indicated that the estimated number of people impacted by the unwinding has gone up to 260,000.

Of that group, an estimated 85,400 have incomes over 138% of the federal poverty level, the Medicaid limit, and will qualify for a qualified health plan with federal tax credits through Kynect. 

Private insurance plans purchased on Kynect offer significant tax subsidies to offset insurance costs for people earning between 100% and 400% of the federal poverty level, or between $13,590 and $54,360 for an individual. About 80% of enrollees nationwide qualify for subsidies that reduce their monthly payments to less than $10, according to the federal Department of Health and Human Services.

ACA open enrollment has been extended until 3 a.m. ET Wed., Dec. 18, but federal officials haven't made a very big deal of it

Open enrollment for "Obamacare" health insurance has been extended until 3 a.m. ET on Wednesday, Dec. 18, because of extensive computer glitches that happened over the weekend.

The original deadline was 11:59 p.m. on Sunday, Dec. 15. The last day is always the busiest, but many people trying to enroll via the website or by phone ran into delays and other issues. Despite the problems, the Centers for Medicare and Medicaid Services said in a statement that more than half a million people were able to enroll on Sunday. According to CMS, "people who already left their names and contact information with the call center on Sunday don’t need to come back and reapply because a representative will follow up with them later in the week," Ricardo Alonso-Zaldivar reports for The Associated Press.

The nonprofit Get America Covered urged the administration to extend the sign-up. The group was founded by ex-Obama administration officials to get the word out about ACA open enrollment after the Trump administration halved the sign-up period and slashed budgets for advertising, outreach and "navigators," people who help others sign up for coverage, Alonso-Zaldivar notes.

Get America Covered co-founder Joshua Peck applauded the extension, but said he worries that the administration isn't doing much to publicize or clarify it. The HealthCare.gov home page still says in big letters that open enrollment is over. A banner with much smaller letters at the top of the page says it has been extended, which could confuse users, Sarah Gantz reports for The Philadelphia Inquirer.

"Senior lawmakers of both major parties are urging the administration to publicize the availability of a redo for seniors who got inaccurate or confusing results using the Medicare Plan Finder. A redesign of the Medicare site produced search results that didn’t automatically rank the prescription drug plan with the lowest total cost first," Alonso-Zaldivar reports.

Peck noted that there were serious glitches on the first day of open enrollment too, and called on CMS to not only extend the deadline and publicize it more, but to also commit to being transparent about what caused the glitches and what the agency has done to ensure they won't happen again, Gantz reports.

One Affordable Care Act insurer in Kentucky wants a 12% rate hike next year; the other one has asked for a decrease of 4.5%

By Melissa Patrick
Kentucky Health News

One of the two insurers offering government-subsidized individual health plans in Kentucky for 2020 is asking for a 12 percent increase, while the other is asking for a 4.5% decrease.

Insurers offering plans for small groups under the Patient Protection and Affordable Care Act are asking for average hikes of 10.5%. These overall percentages reflect an average that will vary, depending on whether individuals smoke, how old they are and where they live.

Anthem Health Plans of Kentucky requested an average 12% increase for the 13 plans to be offered.

CareSource Kentucky requested an average rate decrease of 4.5% for its 12 individual plans.

The requests are preliminary and subject to change. The Kentucky Department of Insurance can approve, lower or raise the rates. The department said in a press release that it expects to finalize the rates by August, which is also when it will finalize any expansion of the plans' service areas.

This year, Anthem offered plans in 93 of the 120 counties, and CareSource offered plans in 61. In 34 counties, both insurers offered plans, but in 16 of those the Anthem plans have a narrow network of providers.

“From our initial review, it appears that the popular silver and bronze plans offered by both insurers receive either a much smaller average increase or comprise the majority of the decreases when compared to other plans,” Insurance Commissioner Nancy G. Atkins said in the release. “Over 90% of the participants select one of these plans, and we anticipate this trend to continue.”

Last year, Anthem asked for an average 3.5% increase and CareSource asked for a 19.4 % hike. The Insurance Department gave Anthem a higher increase than it asked for at 4.3% and CareSource got the 19.4% it requested.

Kentucky saw 84,620 residents enroll in subsidized coverage via Healthcare.gov during the open enrollment period for 2019. That was a 5.5% decrease from 2018, when 89,569 Kentuckians enrolled, but up 4.3% from 2017, when 81,155 enrolled. Kentucky has yet to reach the same number of enrollees as it did in 2015, when 106,330 enrolled. The state shifted enrollment to the federal exchange in 2016, away from the state-based exchange called Kynect. Open enrollment for 2020 begins Nov. 1.

This is the last week to sign up for health insurance on Healthcare.gov for 2019 coverage; deadline is Saturday, Dec. 15

By Melissa Patrick
Kentucky Health News

With just a few days left to enroll in a health-insurance plan on Healthcare.gov, it's time to sign up if you want federally subsidized coverage for 2019. Enrollment under the Patient Protection and Affordable Care Act, otherwise known as Obamacare, ends Saturday, Dec. 15.

Screenshot of Healthcare.gov website

If you need help with enrolling or simply have questions, there are more than 600 application assisters and more than 2,000 insurance agents available to help -- and their services are free, Edith Slone, director of the Kentucky Health Benefit Exchange, said on a Dec. 3 video posted on the Cabinet for Health and Family Services Facebook page.

And even though you will be automatically re-enrolled in a 2019 marketplace plan if you already have one, that doesn't mean you shouldn't check out the other options.

Slone said open enrollment is a good time for an "annual health care checkup" to make sure your coverage suits your needs. Has the number of people in your household has changed? Has your income or medical needs changed? Or are your providers still in your plan network?

And don't assume you can't afford coverage.

Slone said 80 percent of Kentuckians who sign up on healthcare.gov will qualify for a tax credit or subsidy to reduce their monthly payments. And while premiums have gone up this year, most enrollees' cost will be about the same because the credits are calculated to offset premium increases.

Whether Slone's Facebook message is reaching the Kentuckians who need to hear it is uncertain, especially since five weeks into the six-week enrollment period, 6,142 fewer Kentuckians had enrolled on the federal exchange than at the same time last year.

Kentucky's enrollment on the federal exchange during November was 30,172, compared to 36,314 who had enrolled by that time last year, according to the Centers for Medicaid and Medicare Services. Nationally, 406,277 fewer people had signed up compared to last November. However, these numbers don't reflect any automatic re-enrollments.

There are many possible reasons for lower enrollment, including the removal of the individual mandate that imposed a penalty for not having health insurance, expansion of availability of "short-term" plans, and huge cuts to many states' in-person outreach and advertising budgets -- though Kentucky still funds its application-assister program.

But the most likely reason is that people don't know it's time to sign up, which is a problem because if you miss the deadline -- and don't qualify for a special enrollment period -- you won't get another chance until next year.

According to a Kaiser Family Foundation poll taken last month, only one in four people who buy their own insurance or who are uninsured knew the correct deadline for open enrollment -- Dec. 15. And fewer than half of those polled said they had heard or seen any advertising in the past 30 days from an insurance company attempting to sell health insurance. Only 31 percent said they had heard or seen information about how to get health insurance under the health-care law.

Kentucky's Cabinet for Health and Family Services said in an Oct. 30 news release that it was targeting its outreach efforts through direct mail, text messages, phone calls, e-mail and community outreach events held by local assisters. The cabinet has also posted some outreach messaging on its Facebook and Twitter accounts.

In Arkansas, there seems to be a greater sense of official urgency. The state Health Insurance Marketplace issued a news release on Dec. 3 that emphatically reaches out to its citizens to tell them to "hurry" and sign up for open enrollment because the Dec. 15 deadline is looming.

"Those families and individuals are one catastrophic illness away from potential financial bankruptcy. We insure everything else important in our lives -- homes, autos, boats -- why not our health?" says the release from Brett Kirkman, chairman of the marketplace board.

Nationally, celebrities such as late-night television talk-show hosts Stephen Colbert and Jimmy Kimmel have stepped up their efforts to let people know the deadline is looming.

Kentucky's cabinet has not issued another news release to encourage sign-ups, and did not respond to a request for comment as to whether it plans to.

Where can I find help?

The state-based call center is available at 855-459-6328 to help assist Kentuckians with where to go for coverage, answer questions and pre-screen for eligibility. The Healthcare.gov customer service center (800-318-2596) is also available 24 hours a day, seven days a week.

Click here to find an assister or click here to find an insurance agent or an assister. Click here to see a list of outreach events in each county.

Healthcare.gov provides a shopping tool to allow you to preview 2019 plans and estimated prices before you log in.

The Kaiser Family Foundation also offers a Health Insurance Marketplace Calculator to provide estimates of health insurance premiums and subsidies for people purchasing insurance on their own on Healthcare.gov. It allows you to enter your income, age and family size to estimate your eligibility for subsidies and how much you should spend on health insurance. It will also allow you to see if you qualify for Medicaid.

As more lack health insurance and signups lag, Modern Healthcare editor worries what will happen if economy slows

The share of Kentucky children without health insurance rose last year.

"This shouldn't be happening," Editor Merrill Goozner writes in a Modern Healthcare editorial titled, "The canary in the open-enrollment coal mine."

Goozner is writing about an increase in the number of uninsured children and a decrease in the number of people who are signing up for federally subsidized health insurance for 2019. "The share of Americans without health coverage will undoubtedly tick up next year for the first time in nearly a decade," writes Goozner.

"This dubious achievement arrives just as the U.S. economy is nearing full employment," a time when employers are bolstering their benefit packages to attract workers, and people working in jobs that don't offer health insurance are finally making enough money to buy some, he writes.

"It clearly took a lot of work by the Trump administration and the current Congress to undermine the exchanges where individual policies are sold," he writes, ticking off many of their efforts to do so: removing insurance price stabilizers, ending cost-sharing subsidies for patients, slashing marketing and advertising budgets, expanding the availability of "short-term" plans, and doing away with the individual mandate that imposed a penalty for not having health insurance.

"If the current sign-up rate holds through the end of open enrollment on Dec. 15, more than 2 million fewer people will choose plans on the exchanges for 2019, about a 17 percent decline from 2018," he writes. "This will almost entirely offset the increase in employer-based coverage that one would expect from an improving economy."

He adds that states being allowed to add work requirements to their expanded Medicaid populations will only exacerbate this problem, pointing to Arkansas, which has dropped 12,000 from its Medicaid rolls since it implemented its work requirements three months ago. "It could get much worse," he writes, since Centers for Medicaid and Medicare Services Administrator Seema Verma has vowed to push for the requirements.

In addition to Arkansas, the Department for Health and Human Services has approved Medicaid work requirements in Kentucky, Indiana, New Hampshire and Wisconsin, with approvals pending for Alabama, Arizona, Kansas, Maine, Michigan, Mississippi, Ohio, South Dakota and Utah.

"It's poor timing for ideological rigidity," he writes. "If the economy slows next year, which many economists predict, the last thing you want to do is create higher hurdles for low-income people needing Medicaid." But with only one week left in open enrollment, Goozner writes that "the die for next year is mostly cast."

He warns that hospitals and providers need to begin preparing now for the coming fiscal realities, noting that they should expect another "upward lurch" in uncompensated care next year and prepare for a freeze on hiring.

He concludes: "You'd think the Trump administration would understand that's not what it wants going into a two-year battle to win re-election."

Deadline to sign up for health insurance on Healthcare.gov is Dec. 15, but most who qualify didn't know that last month

By Melissa Patrick
Kentucky Health News

With just two weeks left to sign up for federally subsidized health insurance for 2019, time is running out. The deadline for open enrollment on Healthcare.gov is Dec. 15, and fewer Kentuckians are enrolled than at this time last year.

Four weeks into the six-week enrollment period, Kentucky enrollment on the federal exchange was 22,565. That was 5,414 fewer than the 27,979 who had enrolled by that time last year. Nationally, 356,347 fewer people had signed up. These numbers only reflect people who had signed up for a new plan or who had actively chosen a plan; those who already have plans on Healthcare.gov and don't choose a new one will be automatically re-enrolled, and those numbers haven't yet been included in the enrollment reports.

"Last year, just under half of the signups came in the final week due to auto-enrollment," Dustin Pugel, a research and policy analyst for the Kentucky Center for Economic Policy, said in an email. "So I have no reason to expect we won't see a big jump again this year the week of Dec. 15."

That said, Pugel cautioned that he is uncertain how the enrollment numbers will end up, noting that while the marketing and outreach budgets were cut, open enrollment got a lot of free publicity last year because Congress debated repealing the Patient Protection and Affordable Care Act, also called Obamacare, from January to early October.

"This year, open enrollment is neither getting the free attention nor the paid outreach and marketing, so I am concerned that many who qualify won’t end up getting coverage because they don’t realize they qualify for financial assistance, or that the open enrollment period is short (again)," Pugel said.

The open enrollment period originally lasted last three months, but the Trump administration shortened it last year to 45 days.

Most people don't know the deadline is looming.

According to a Kaiser Family Foundation tracking poll taken Nov. 14-19, only one-fourth of people aged 18 to 64 who buy their own health insurance, or are uninsured, knew that the last day to purchase health insurance on Healthcare.gov is Dec. 15.

Sixty-one percent said they didn't know when the deadline was, and 16 percent either had the date wrong, said there was no deadline, said the deadline had passed, or refused to answer the question.

Fewer than half of those polled said they had heard or seen any advertising in the past 30 days from an insurance company attempting to sell health insurance. Only 31 percent, said they had heard or seen information about how to get health insurance under the health care law. Most television commercials are for Medicare enrollment, which ends Dec. 7.

Another possible reason for lower sign-ups is that this is the first year people don't have to pay a penalty for not having health insurance, referred to as the removal of the individual mandate. But the problem with this theory is that most people don't know the requirement has been repealed.

According to the poll, 38 percent didn't know there was no longer a penalty for not having health insurance. An additional 31 percent, were unsure. Only 31 percent knew the law had changed.

The poll also found that about half of those who were uninsured or buy their own coverage said they plan to buy insurance for 2019, despite the elimination of the fine, while 42 percent said they would choose to go without coverage.

The Trump administration has also finalized a rule that allows the sale of short-term health insurance policies -- which are generally less expensive than the ACA-compliant plans and offer limited coverage -- that could lure some away from buying insurance on the exchange.

The poll found that 70 percent of those who purchase their own insurance or are uninsured said they would choose to keep the plan they have now and 21 percent of them said they would buy a short-term plan. Click herefor a Kaiser Family Foundation fact sheet on short-term plans.

Time's a-wastin'

The bottom line is that it's time to sign up for health insurance on Healthcare.gov if you want health insurance next year.

Don't assume you can't afford it, because most people in the marketplace qualify for financial help to lower their costs. The Cabinet for Health and Family Services has reported that about 80 percent of Kentuckians enrolled through the federal exchange qualified for tax credits and subsidies that reduced their premiums.

It is also suggested that even if you have a plan on Healthcare.gov, it's a good idea to look at all of your options each year to make sure you have the plan that best suits your needs.

Where can I find help?  The state-based call center is available at 855-459-6328 to help assist Kentuckians with where to go for coverage, answer questions and pre-screen for eligibility. The Healthcare.gov customer service center (800-318-2596) is also available 24 hours a day, seven days a week.

 Click here to find an application assister or an insurance agent near you. Click here to see a list of outreach events in each county.

Whitney Allen, the coordinator of community development and outreach for the Kentucky Primary Care Association, said this about application assisters: "Assisters are trusted members of the community you live in that are experts in the health insurance enrollment process and offer free, unbiased help. From Medicaid to Marketplace, they are the one-stop-shop to answering your health insurance questions about getting covered, staying covered and how to use your health insurance effectively."

Healthcare.gov provides a shopping tool to allow you to preview 2019 plans and estimated prices before you log in.

 The Kaiser Family Foundation also offers a Health Insurance Marketplace Calculator to provide estimates of health insurance premiums and subsidies for people purchasing insurance on their own on Healthcare.gov. It allows you to enter your income, age and family size to estimate your eligibility for subsidies and how much you should spend on health insurance. It will also allow you to see if you qualify for Medicaid.

Some Republican senators, including Rand Paul, don't like Mitch McConnell's strategy of drafting health bill in secret

Kentucky Health News

Senate Majority Leader Mitch McConnell continues to catch heat from Democrats, and dissatisfaction from some Republicans, about Senate Republicans' secret drafting of a repeal-and-replace-Obamacare bill that he wants passed by June 30.

At the congressional baseball game, McConnell and Schumer
gave their first joint interviews, as did House Speaker Paul Ryan
and House Minority Leader Nancy Pelosi. (AP photo by Alex Brandon)

Senate Democratic Leader Chuck Schumer of New York told the Kentuckian in a letter that they should convene a meeting of all 100 senators "on the topic of health care," which "affects every single American and one-sixth of our economy. We believe we all owe it to our constituents to pursue any bipartisan potential legislation because it profoundly impacts so many American lives."

Schumer told reporters, “They’re ashamed of the bill. If they liked the bill, they’d have brass bands marching down the middle of small-town America saying what a great bill it is. But they know it isn’t.”

McConnell spokesman David Popp "argued that the letter suggests Democrats are now open to the 'repeal' component of the 'repeal and replace' health care effort," CNN reports. "He alluded to Schumer's comments earlier this year in which he said Democrats will work with Republicans on repairing Obamacare as long as Republicans back off of the 'repeal' part of it."

Popp noted that Schumer's letter said Democrats would like to "discuss how to make health care more affordable and accessible." Popp said that was an admission that Obamacare is neither. "That admission is another positive step from a party that, until now, has been wedded to the unsustainable status quo and its consequences for families across the country," he told CNN, urging Democrats to "propose ideas."

Meanwhile, seven governors — four Democrats and three Republicans — wrote McConnell and Schumer, asking that senators in both parties be allowed to help draft the bill. McConnell has said he wouldn't involve Democrats in drafting because "They're not interested in doing anything that we're interested in doing," and hearings aren't needed because the issues are well known.

Republican grumbles

The lack of "a formal, open drafting session . . . has created an air of distrust and concern — on and off Capitol Hill, with Democrats but also with Republicans," report Thomas Kaplan and Robert Pear of The New York Times. "The secrecy surrounding the Senate measure to repeal and replace the Affordable Care Act is remarkable — at least for a health-care measure this consequential."

Sean Sullivan and Kelsey Snell of The Washington Post report, "Rank-and-file Republican senators are increasingly frustrated that McConnell and a small group of GOP aides are crafting a bill behind closed doors."

They quote Sen. Bob Corker, R-Tenn.: “I’ve said from day one, and I’ll say it again. The process is better if you do it in public, and that people get buy-in along the way and understand what’s going on. Obviously, that’s not the route that is being taken.”

The Times reports, "Mr. McConnell said there had been 'gazillions of hearings on this subject' over the years — a less-than-precise tabulation that offered little comfort to Democrats who want hearings held now, in this particular year, on the contents of this particular bill."

Corker is not the only Republican who wants to know more, and sooner. McConnell's Kentucky colleague, Rand Paul, asked reporters if they had a copy of the bill, and if so, whether he could have one. Paul is considered one of the Republicans least likely to support the bill, since he said the House version didn't go far enough. “My preference would be a more open process in committees, with hearings and people on both sides,” he told the Times.

Among Republican senators, "Few seem to have a clear, coherent picture of what will be in the legislation," the Times reports, quoting Ron Johnson of Wisconsin: “I come from a manufacturing background. I’ve solved a lot of problems. It starts with information. Seems like around here, the last step is getting information, which doesn’t seem to be necessarily the most effective process.”

Republican rationale

The Post reports, "Senate leaders argued that they are keeping a tight grip on emerging bill language a secret because they are writing several different policy options for each section of the bill. They worry that sharing any one piece out of context could give a distorted impression of what the final bill will include."

The Times says, "It is not unusual for lawmakers to draft major legislation in private, but they usually refine, debate and amend it in open committee sessions. The House bill to repeal the Affordable Care Act did not receive a hearing where outside experts could have testified, but lawmakers dissected its contents and were able to propose changes at three stages: in the Ways and Means, Energy and Commerce, and Budget Committees. Senate Republican leaders evidently think their back-room approach gives them the best chance to devise a health care bill that can squeak through the Senate, given their narrow majority and the policy differences in their conference."

Fifty-two senators are Republicans, allowing defection by only two to let a bill pass with the tie-breaking vote of Vice President Mike Pence. McConnell plans to bring the bill to a vote by June 30, the last day before a week-long recess, the Post reports. If it passes, a House-Senate conference committee would be named to work out the differences.

"The largest, most enduring clash within the Senate is over the future of Medicaid," the Post notes. "Republican senators are at odds over how much and how quickly to pare back federal spending on the program, which expanded under Obamacare and added millions of Americans to the rolls of the federally insured." It added 470,000 Kentuckians.

Does McConnell really want to pass a bill?

Jennifer Rubin, a conservative columnist for the Post, wonders whether McConnell really wants to pass a bill: "There are two possibilities here: First, McConnell has some magic formula for getting the votes of all but one senator (if Paul is indeed a “no” vote ) in a conference that includes far-right ideological twins Sens. Ted Cruz (R-Tex.) and Mike Lee (R-Utah) and moderates such as Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska), who among other things object to rolling back Medicaid or blocking Planned Parenthood funding. If such a formula exists, McConnell would have to think he can garner support in lightning speed, hold off uniform Democratic objections and ignore concerns from outside groups (doctors, hospitals, insurers). I suppose anything is possible, but such a process would be unique in Senate history.

"The other possibility is that McConnell knows this is impossible. He has set an entirely artificial deadline that cannot be met precisely because he knows health-care reform won’t happen. He wants to wipe the slate clean and move on to other issues such as tax reform and the budget — before those issues become untenable. He is experienced enough to know that this administration and the dysfunctional House are entirely capable of careening toward a government shutdown in the fall. Therefore, the sooner Congress can turn to these items, the better."

The Times notes, "While much of the Affordable Care Act was written in the open, some important provisions were hashed out in private, just before the Senate vote, by Senator Harry Reid, the Nevada Democrat who was then the majority leader. Republicans complained bitterly at the time, and Democrats threw those complaints back at them this week. 'This massive piece of legislation that seeks to restructure one-sixth of our economy is being written behind closed doors, without input from anyone, in an effort to jam it past not only the Senate but the American people,' Mr. McConnell said in December 2009, using words that could be spoken by any Democrat today."