Kentuckians' enrollment in Affordable Care Act plans is 10.4% higher than 2017, 4% below 2016; county data available

Over 10 percent more Kentuckians signed up for Obamacare health insurance in the recent enrollment period than the one a year ago, contrary to the national trend for enrollment under the Patient Protection and Affordable Care Act.

The Kentucky enrollment was 89,569, a 10.4 increase from last year's 81,155, and just 4 percent under the 93,666 who enrolled in 2016. That was the last year before the administration of Gov. Matt Bevin moved enrollment to the federal HealthCare.gov website.

Nationally, Obamacare enrollment was down 4.2 percent, to 11.75 million from 12.7 million in 2016 and 12.2 million in 2017, according to federal reports compiled by ACAsignups.net.

Data from the Centers for Medicare and Medicaid Services show that 27,598 of the Kentucky enrollees, or 31 percent, were new to Obamacare. Of the 61,971 who re-enrolled, 28 percent were re-enrolled automatically; the rest were active re-enrollees, usually switching plans from last year.

Most of those switched from a typical "silver" plan to a cheaper "bronze" plan with higher thresholds and co-payments. About five in eight active re-enrollees switched plans; that doesn't count those who "crosswalked" to a similar plan from one that was changed or eliminated.

About 76 percent of Kentuckians on Obamacare have their premiums subsidized by "advance premium tax credits," granted upon enrollment, and 42 percent are getting cost-sharing reductions that are gauged by income.

The average monthly premium for Obamacare insurance in Kentucky is $544, but after the tax credit it is only $201. That average includes people who don't get financial assistance and have seen major increases in their premiums.

Among the Kentuckians who are getting the tax credit, the average credit is $455, and the average monthly premium for those receiving a credit is $124. The national average is $89 a month.

Of the 135,606 Kentuckians who applied for coverage on 91,240 applications, 76,794 were found to be eligible for tax credits, and another 25,914 were found to be eligible for free coverage through Medicaid or the Children's Health Insurance Program. Medicaid covers 1.44 million Kentuckians, about 493,000 of them under the program's expansion under the Affordable Care Act.

For county-by-county data on Medicaid, in an Excel spreadsheet, click here. For a spreadsheet of county-by-county enrollment in ACA plans, go here. A spreadsheet of ACA enrollment by ZIP code is also available, from a page on the CMS website.

In a report for PBS, KET's Renee Shaw looks at the influence of health-care reform on the U.S. Senate race

Kentucky is a state "where both the economy and health care poll as high issues and where the state’s exchange under the health care law ... has a very different reputation than the law does when it’s called Obamacare," KET's Renee Shaw reports in a segment for PBS "NewsHour."

Courier-Journal Political Writer Joe Gerth explained the disconnect for the national audience: "Five letters, O-B-A-M-A. You have to look at the polling on Obama. His favorability rating in Kentucky is somewhere around 29 percent. He’s not liked. People don’t like his policies. They don’t like him personally. And that’s played a huge role in why Obamacare is viewed so negatively."

Shaw interviews small-business owner Charles Howard of Chaplin, who doesn't like the law, and Kendell Nash of Louisville, who does. Shaw concludes, "Kentucky is full of strong feelings on the health care law, but it’s not clear how much those will affect the election. Like much of the nation, the state is getting ready for the next round of open enrollment on its health care exchange. That will be the next test of the health care law here. Enrollment starts two weeks after the midterm election."

Poll: Kentuckians still oppose Obamacare, but favor fixes, not repeal, and think state insurance exchange works well

Most Kentuckians still oppose the federal health-reform law, but think it should be changed rather than repealed, and most think the state health-insurance exchange created under the law is working well. So says a poll taken for The New York Times and the Kaiser Family Foundation in four Southern states with key U.S. Senate races this year: Arkansas, Kentucky, Louisiana and North Carolina.

"Debate over the law is expected to dominate the midterm elections. Attacks on the law are featuring prominently in campaigns across the country, and Republican lawmakers have continued to push for the law’s replacement," Sabrina Tavernise and Allison Kopicki write. "Questions about it may evoke associations with an unpopular president, the remoteness of Washington from ordinary Americans and extra costs in family budgets. But majorities say they do not want it taken away, even in states that lean Republican in presidential elections."

Among the four states, Kentucky is the only one that is running its own exchange, and the only one in which a majority said it is working well. In Arkansas, which has a combined state-federal exchange, a plurality said it was working well. The other two states use the federal exchange, which had a troubled rollout.

Kentucky is the only Southern state that created its own exchange and expanded Medicaid to include people in households with incomes up to 138 percent of the federal poverty level. The poll found support for Medicaid expansion in all four states, and 55 percent in Kentucky gave Gov. Steve Beshear, who made both decisions, a positive job rating.

The poll, done with landline and cellphone interviews April 8-15, has a margin of sampling error of plus or minus 4 percentage points in each state. (Read more)

Biggest problem with health-care reform law is advocates' poor sales job to the American public, Rep. John Yarmuth tells C-J

By Tara Kaprowy
Kentucky Health News

The biggest problem with the federal health-care reform law is not the law itself, but the fact that "We've never done as good a job as we could have" in explaining what it is about, Democratic U.S. Rep. John Yarmuth of Louisville told the editorial board of The Courier-Journal Friday.

In his lengthy interview, Yarmuth said the problem started at the law's inception when President Obama outlined his parameters but  let Congress decide what the bill should be. "The challenge was explaining what the bill even was because we didn't know what it was going to be," he said.

The issue was compounded by the fact that, unlike energy legislation where its "impact is relatively uniform," with health care "everyone wants to know how it will affect you and your family ... and it's all different," Yarmuth said. "It's hard to market something individually to 300 million people."

Also contributing to the problem is the complexity of the subject itself, which Yarmuth likened to "the biggest Rubik's cube that ever existed," since "Every time you move one piece, 100 pieces move."

That has resulted in deeply-seated misconceptions about the law that are difficult to undo. The biggest, he said, is "that it is some form of government takeover." Those with that view note that the law's individual mandate in the law will force people to buy insurance or pay a fine, and the law will impose new rules on health-insurance companies and put many other controls on the system.

But Yarmuth argues the law uses "free enterprise and competition" to "provide more affordable care for individuals." Indeed, state insurance exchanges will feature different benefits packages from private companies from which people who qualify for the exchange can choose. People who qualify for the exchange — those who earn up to 400 percent of the federal poverty level — will be given subsidies in the form of tax breaks to help pay for their premiums. "The reason why the Republicans don't have an alternative is Obamacare was their alternative," Yarmuth said. "This was their plan: creating competition among insurers and letting them compete for individual business."

Another misconception is that people who don't have health insurance are "deadbeats," Yarmuth said. But he said 37 percent of Americans who are uninsured make over $50,000 a year and almost 20 percent make over $75,000 a year (those percentages are confirmed here). "No, these are solid citizens," he said. He pointed out that all families pay the cost of those who are uninsured, adding that an estimated $1,000 of every health insurance policy goes toward paying for uncompensated care.

Yarmuth said in Kentucky nearly $600 million is spent on uncompensated care each year. (A Kentucky Hospital Association report estimated it is far higher: $1.67 billion in 2010.) Regardless of the figure, Yarmuth said losses could be offset by expanding Medicaid, a claim supported by a report by the Urban Institute. Expansion would cover almost 300,000 Kentuckians and would cost the state $515 million through 2019, he said. "It will bring in $12 billion of federal money," he said. "Is that a good trade-off?"

Asked how provisions in the law would be paid for, Yarmuth acknowledged "If you're adding 30 million more people, it's going to add cost to the system." Ultimately, costs will continue to go up but "less than they otherwise would," he said. He referred to pre-law estimates by the Congressional Budget Office that the cost of employer-based insurance would double to $25,000 a year for a family of four, but the law seems to have slowed that trend. Yarmuth referred to an article published in the journal Health Affairs that indicated that between 2010 and 2011, overall national health-care expenditures increased by 3.9 percent. "That's the lowest rate of growth in the last 50 years," he said. "It is having an effect." The CBO estimated the law will reduce the deficit over the next 10 years by $130 billion, with an estimated $1.2 trillion saved in the second 10, Yarmuth noted. "We all knew we were on an unsustainable path."

But most still don't know that, and on Saturday, a day after the Yarmuth interview, the C-J editorial board criticized Democrats for not doing a better job getting their message out about the new law: "The problem is partially that the law is complex and 2,000 pages long. It's partially that the Republicans have successfully put the Democrats on the defensive, forcing them to defend the law to people who have already had the GOP message driving into their heads. But it's also that the Democrats don't trust that the American people will be willing or able to understand them when they defend the health-care law."