Many Kentucky residents were deeply skeptical of Obamacare, but the Bluegrass State is now touted as an ACA success story. It has experienced a dramatic decline in uninsured thanks to its state-run exchange and Medicaid expansion. However, healthcare reform efforts are at risk in Kentucky.
This brief summary to explains where Kentucky has been in terms of public health and insured rates, and how the Affordable Care Act and current politics may shape the future of these important quality-of-life measures.
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 Commonwealth Fund’s 2014 Scorecard on State Health System Performance ranks Kentucky 42nd, down from 40th in 2009. The evaluation compares more than 40 measures to arrive at an overall health score for each of the 50 states and the District of Columbia. Kentucky fell into the fourth quartile when it came to measures related to avoidable hospital use and costs as well as healthy lives. See Kentucky’s Scorecard to see its performance on specific measures.
Kentucky also ranks among the bottom 10 percent of states in America’s Health Rankings, which are compiled by the United Health Foundation. Kentucky was ranked 47th out of the 50 states in 2014, down from 45th in 2013. The Bluegrass state ranked last in four measures: cancer deaths, children in poverty, poor mental health days and preventable hospitalizations. Its ranking was positively impacted by low rates of violent crime and binge drinking, as well as a relatively low disparity in health status among adults with and without a high school education.
You can find additional public health indicators in the 2015 edition of the Trust for America’s Health report. See Key Health Data About Kentucky. Focus on a particular area of the state with county-by-county health rankings for Kentucky from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.
Kentucky and the Affordable Care Act
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 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.
At the state level, Gov. Steve Beshear’s support of the ACA has repeatedly drawn 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 is 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 promises to dismantle Kynect and transition the state to Healthcare.gov when he takes office. He also says he will 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.
How has Obamacare helped Kentucky?
Kentucky made the headline of Gallup’s findings about nation’s uninsured rate after the Affordable Care Act’s individual mandate went into effect. Kentucky saw the nation’s second largest drop, going from an uninsured rate of 20.4 percent in 2013 to 9.8 percent by the end of 2014. Only Arkansas, with an 11.1 percentage point decrease, experienced a greater decline in its uninsured population.
Following the second Obamacare open enrollment period, Kentucky held position as the state with the second-largest reduction in its uninsured population. The state’s uninsured rate fell 11.4 percentage points from 2013 to 9 percent by June 2015 – a 55.8 percent reduction. As of June 2015, the average uninsured rate among states that both expanded Medicaid and formed a state-run exchange was 8.9 percent with an average reduction of 44 percent.
Kentucky enrollment in qualified health plans
Nearly 83,000 Kentucky residents signed up for qualified health plans (QHPs) during the 2014 open enrollment period. That’s 27.4 percent of the estimated eligible market of 302,000 people. For comparison, Vermont led the nation with a sign-up rate of 85.2 percent of its eligible residents, and the national average of 28 percent.
By the end of the 2015 open enrollment period, 106,330 people had enrolled in QHPs through Kentucky’s state health insurance exchange. An additional 3,047 were enrolled during the state’s special enrollment period, which ran from March 2 to April 30.
However, some individuals cancelled their coverage or failed to make their first premium payments. By June 30, 2015, there were 88,904 people enrolled in private health insurance plans through Kynect – 69.8 percent of them were receiving premium tax credits and 38.1 percent were enrolled in silver plans with cost-sharing reductions.
Kynect is making a big push to enroll Kentucky’s remaining uninsured during 2016 open enrollment with community outreach focused on 18 counties where the uninsured rates are highest. Forty-three percent of the state’s 285,000 uninsured are eligible for Medicaid under Kentucky’s expanded eligibility guidelines.
The Kentucky Health Cooperative announced its closure at the end of 2015, which means it will not offer 2016 coverage through Kentucky’s state-run exchange. However, the Kynect added three more carriers offering 2016 health plans, bringing the total to seven – when the exchange launched for 2014, it only had three carriers:
- Aetna – new for 2016
- Anthem BCBS
- Bluegrass Family Health – new for 2016
- CareSource Kentucky
- Wellcare Health Plans
- Kentucky Health Cooperative
- UnitedHealthcare – new for 2016
Not all carriers offer health plans in all counties. Given Kentucky’s shifting market, consumers are encouraged to shop around and compare plans rather than automatically renew their existing coverage
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 ($16,105 a year for one person or $32,913 for a family of four) 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.
From 2013 to August 2015, Kentucky Medicaid enrollment increased 87 percent, the biggest change nationwide. Nevada saw the second-biggest change with a 73 percent increase. Enrollment in Medicaid and CHIP continues throughout the year, which means this number is constantly changing.
Does Kentucky 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.
Other ACA reform provisions
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, 24 CO-OPs were set up as of January 2014, including the Kentucky Health Care Cooperative. However, 12 of them, including Kentucky’s, have folded.
Medicare enrollment in the Bluegrass State
Kentucky has the highest percentage of Medicare recipients listed as disabled: 28 percent. The other 72 percent qualify for Medicare based on age alone. Medicare pays about $9,634 per Kentucky enrollee each year, and the state ranks 24th in terms of overall spending with $7.2 billion annually.
Kentuckians who want additional benefits beyond those offered through original Medicare can opt for a Medicare Advantage plan instead, and 26 percent of Kentucky beneficiaries selected Medicare Advantage in 2015. Nationally, 32 percent of Medicare beneficiaries choose a Medicare Advantage plan over traditional Medicare coverage.
Medicare Part D plans provide a way for Medicare recipients to gain stand-alone prescription drug coverage. About 53 percent of Kentucky’s Medicare recipients enroll in a Medicare Part D plan, compared with 43 percent nationwide.
Kentucky’s state-based reform legislation
Here’s what’s happening legislatively in Kentucky with healthcare reform at the state level: