Health insurance in Kentucky
- Kentucky originally operated its own exchange, Kynect, but transitioned to HealthCare.gov in the fall of 2016.
- Open enrollment for 2020 coverage in Kentucky runs from November 1 to December 15, 2019. Outside of that window, residents must have a qualifying event in order to purchase ACA-compliant coverage, on-exchange or directly from an insurer.
- Short-term health plans can be sold in Kentucky with initial plan terms up to 364 days.
- Two insurers are offering 2020 coverage in Kentucky’s individual market.
- Average 2020 rate changes: 9.7% increase for Anthem; 4.5% decrease for CareSource.
- Almost 85,000 Kentucky residents enrolled in 2019 coverage through the exchange (fewer than 2018, but more than 2017).
- The Kentucky Health Care Cooperative is one of 19 ACA CO-OPs that have folded.
- After Kentucky adopted the ACA’s Medicaid expansion, the state experienced the largest percentage increase in Medicaid enrollment of any state.
- Kentucky planned to implement a work requirement in April 2019 that would have reduced Medicaid enrollment by nearly 100,000 people. But a federal judge blocked it before it could take effect.
- Kentucky defaults to new federal rules regarding short-term health insurance.
- More than 20 percent of Kentucky residents are enrolled in Medicare. Twenty-eight percent of those beneficiaries had Medicare Advantage coverage.
Kentucky’s health marketplace
Kentucky initially operated its own exchange and enrollment web site, Kynect, and the state-run exchange was widely considered one of the most successful state-run exchanges in the country. But Gov. Matt Bevin, who took office in late 2015, followed through on a campaign promise to transition the Kentucky exchange to the HealthCare.gov platform.
(Kentucky technically still has a state-run exchange, though, and is one of five states that have state-run exchanges but use HealthCare.gov for enrollment.)
Open enrollment for 2020 coverage in Kentucky runs from November 1 to December 15, 2019. Outside of that window, residents need to have a qualifying event in order to enroll in individual major medical coverage, on-exchange or off-exchange.
For 2020, the state’s exchange is offering individual plans from two carriers (Anthem and CareSource). CareSource expanded its coverage area for 2020, so there are 56 counties where residents can select from both Anthem and CareSource. In the rest of the state, plans are available from one or other of the insurers, but not both.
The average approved rate changes for 2020 are a 9.7 percent increase for Anthem and a 4.5 percent decrease for CareSource.
Kentucky enrollment in qualified health plans
Kynect made a big push to enroll Kentucky’s remaining uninsured during 2016 open enrollment with community outreach focused on 18 counties where the uninsured rates were highest (forty-three percent of the state’s 285,000 uninsured were eligible for Medicaid under Kentucky’s expanded eligibility guidelines).
However, Kentucky’s enrollment in private plans dropped 12 percent from 2015 to 2016, falling from 106,330 at the end of 2015 open enrollment to 93,687 by the end of 2016 open enrollment on Jan. 31. Effectuated enrollment was 74,640 as of March 31, a drop of 20 percent. Nationally, the drop was 13 percent.
Enrollment dropped again for 2017, due to the switch to HealthCare.gov as well as reduced funding for exchange outreach and marketing. Just 81,155 people signed up that year. But for 2018, despite a much shorter open enrollment period (just over six weeks, as opposed to three months), year-over-year enrollment grew by more than 10 percent, to 89,569 people. Rhode Island was the only state that had a higher percentage increase in enrollment from 2017 to 2018.
But enrollment dropped again in 2019, with 84,620 people purchasing coverage during open enrollment. That was about 5.5 percent lower than 2018’s enrollment, but it was still higher than enrollment had been in 2017. And a drop in enrollment in 2019 was expected, given that short-term health plans were expanded by the Trump administration and the individual mandate no long applied after the end of 2018, due to the Tax Cuts and Jobs Act that was enacted at the end of 2017.
Read more about the Kentucky health insurance marketplace.
Kentucky’s failed CO-OP
The ACA established a federal loan program to encourage the creation of Consumer Operated and Oriented Plans (CO-OPs), which are nonprofit, consumer-run health insurance companies. Through the program, 23 CO-OPs were set up as of January 2014, including the Kentucky Health Care Cooperative. However, 19 of them, including Kentucky’s, have folded.
Kentucky Health CO-OP had robust enrollment in 2014, and had planned to expand into neighboring West Virginia for 2016. But the CO-OP shut down at the end of 2015, along with several others that closed at the same time, due in large part to the significant shortfalls in risk corridors funding that year.
Read more about the Affordable Care Act’s CO-OPs.
In addition to implementing a state-run health insurance exchange, Kentucky expanded Medicaid under the Affordable Care Act. Under the expansion, Kentucky residents with household income up to 138 percent of the federal poverty level are eligible for Medicaid.
About 358,000 Kentucky residents were deemed eligible for Medicaid or the Children’s Health Insurance Program (CHIP) during the ACA’s initial open enrollment period (Medicaid/CHIP enrollment continue year-round, but tend to spike during open enrollment due to increased outreach and enrollment assistance).
Kentucky Medicaid enrollment doubled between 2013 and 2019 – by far the largest percentage increase of any state, and more than three times as much as the national average increase of 28 percent.
After the Trump Administration clarified that they would be open to the possibility of work requirements for Medicaid, Kentucky was the first state to receive federal approval to implement a Medicaid work requirement, which was slated to take effect in July 2018. But in June, a federal judge blocked implementation Kentucky HEALTH. The waiver was reapproved by HHS in November 2018, with an effective date of April 2019. but the work requirement was blocked again, just days before it was to take effect. Kentucky and the Trump administration appealed, but the panel of judges on the appeals court expressed the same concerns about coverage losses that had led the lower court to overturn the work requirement (if the waiver is implemented, it’s expected to result in nearly 100,000 people losing coverage — and that estimate might be on the low side). So for the time being, no work requirement has been implemented in Kentucky.
Read more about Medicaid expansion in Kentucky.
Short-term health insurance in Kentucky
Kentucky defaults to the new federal rules regarding short-term health insurance. That means plans sold in the state can have initial terms up to 364 days and a total duration of up to three years, although many of the plans for sale are limited to six months.
Read more about short-term health insurance in Kentucky.
Kentucky health ratings
When it comes to public health, Kentucky faces some challenges. The state has received low rankings from various evaluations in recent years.
The 2016 edition of the Trust for America’s Health report ranked Kentucky 36th for percentage of uninsured, all ages – 8.5 percent of the state’s population was without insurance in 2014. See Key Health Data About Kentucky for additional public health indicators.
Kentucky improved in the 2017 edition of America’s Health Rankings, ranked 42 of the 50 states. An increase in the percentage of the population with health insurance is one of the reasons Kentucky has moved up in the rankings.
How has Obamacare helped KY?
In 2013, Kentucky’s uninsured rate was 14.3 percent — just slightly lower than the national average at that point. But by 2016, the state’s uninsured rate had dropped to 5.1 percent, which was well below the 8.6 percent national average at that point. This reduction was due in large part to the state’s highly successful state-run exchange (Kynect) and the expansion of Medicaid under the ACA.
But when the 2017 open enrollment period began on November 1, 2016, Kentucky residents switched to using HealthCare.gov for enrollment. Kynect had been widely considered among the country’s most successful state-run exchanges. However, Gov. Matt Bevin, who took office in 2015, transitioned the state to the federal enrollment platform in an effort to curtail costs and take advantage of HealthCare.gov’s economies of scale.
Kentucky still has a state-based exchange, but they no longer have the autonomy that goes along with having a state-run enrollment platform. As an example, when the open enrollment period for 2018 coverage was cut in half, 10 of the 12 states with state-run enrollment platforms opted for longer enrollment periods, and most continued to do so for enrollment in 2019 plans. But states like Kentucky, that use HealthCare.gov, don’t have that level of flexibility.
The Affordable Care Act in the Bluegrass State
In 2010 passage of the Affordable Care Act, Kentucky’s two Republican senators voted “no.” Kentucky’s current senators remain firmly opposed to the ACA. Mitch McConnell was re-elected to the U.S. Senate in the 2014 election and took over as majority leader in January 2015. Shortly after his re-election, McConnell joined then-House Speaker John Boehner in vowing to continue efforts to repeal the ACA. Former Sen. Jim Bunning was replaced by Sen. Rand Paul, who says he would not have voted for the ACA and is in favor of seeing the law repealed.
Kentucky’s representatives in the House split their votes on the ACA along party lines, with two yes votes and four no votes. Kentucky’s current Representatives include five Republicans and just one Democrat. One of the Republicans, Thomas Massie, was among 20 Republicans in the House of Representatives who voted no on the American Health Care Act in 2017, which would have repealed several major portions of the ACA. That bill passed in the House, but failed to pass in the Senate and was never enacted.
At the state level, former Gov. Steve Beshear’s support of the ACA repeatedly drew national attention, with even President Obama making note of it during his 2014 State of the Union address. Beshear used an executive order to establish Kentucky’s state-run health insurance marketplace, Kynect.
Kynect was viewed as a model for state-run marketplaces. Beshear also fully supported Medicaid expansion, calling it the “single most important decision” for improving the health of Kentucky residents.
However, on Nov. 3, 2015, Kentucky elected Republican Matt Bevin to be the state’s next governor. Strongly against Obamacare, Bevin promised to dismantle Kynect and transition the state to HealthCare.gov. He was able to do this, since Kynect had been established by executive order in the first place (Kentucky is currently one of five states that has a state-based exchange but uses HealthCare.gov for enrollment).
Bevin also said he would repeal Medicaid expansion as it currently exists and pursue a Section 1115 waiver allowing Kentucky to design its own version of Medicaid expansion and repeal the existing expansion, although 70 percent of Kentucky residents preferred that Bevin keep the state’s expanded Medicaid program as-is. Bevin’s stance on Medicaid expansion softened a bit, but he sought federal approval for his Kentucky HEALTH program. The waiver was approved in January 2018 but – as noted above – a federal judge blocked implementation of Kentucky HEALTH.
Does KY have a high-risk pool?
Before the ACA reformed the individual health insurance market, pre-existing conditions were a barrier to obtaining coverage in nearly all states, including Kentucky. Medical histories were scrutinized during the application process, and people who didn’t meet the health eligibility guidelines were unable to purchase private coverage. Kentucky Access was established in 2001 to offer coverage to people who were not able to get policies in the individual market because of pre-existing conditions.
Under the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. This aspect of reform largely eliminated the need for high-risk pools, and Kentucky Access notified their members that the plan would cease operations at the end of 2013. Insureds were able to transition to private coverage through Kynect instead.
Medicare in Kentucky
Of Kentucky Medicare beneficiaries, 77 percent are eligible due to their age.
Medicare spends an average of $9,449 per Kentucky enrollee each year.
Kentuckians who want additional benefits beyond those offered through original Medicare can opt for a Medicare Advantage plan instead, and 28 percent of Kentucky beneficiaries selected Medicare Advantage in 2017. Nationally, 31 percent of Medicare beneficiaries choose a Medicare Advantage plan over traditional Medicare coverage.
Kentucky’s state-based reform legislation
Scroll to the bottom of the page to see what’s happening legislatively in Kentucky with healthcare reform at the state level.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.