Despite an initially deep skepticism of Obamacare, Kentucky residents have benefited greatly from healthcare reform in recent years. The Bluegrass State is now touted as one of the Affordable Care Act’s biggest success stories, with sharp declines in its uninsured population. Credited for this improvement: adoption of a state-run exchange and Medicaid expansion.
However, Kentucky continues to experience health insurance changes in the age of Obamacare. ACA efforts are at risk as the governor moves to transition to a federal exchange and change how the state’s Medicaid expansion works.
Learn more about the state’s public health and insured rates, as well as how market shifts 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 2015 Scorecard on State Health System Performance ranks Kentucky 40th, up from 42nd in 2014. The state has seen improvements in terms of access to care, which likely contributed to the higher ranking. The number of uninsured adults ages 19 to 64 dropped 9 percentage points from 2014 to 2015 and the number of uninsured children ages 0 to 18 dropped 1 percentage point. Fewer adults went without access to care because of cost—16 percent in 2015, compared with 19 percent in 2014. And while fewer adults over age 15 went without recommended preventive care, the percentage that did not receive it was still more than half (66 percent). Kentucky’s scorecard estimated that if the state were to improve to the level of the best-performing state, 181,802 more adults would be insured and 299,962 fewer adults would go without healthcare because of cost.
At number 44, the Bluegrass State landed in the bottom 10 percent of America’s Health Rankings 2015 as well; however, this was an improvement from 47 in 2014. Partially responsible for this uptick: lack of health insurance decreased 24 percent in the past two years, dropping from 15 percent of the population to 11.4 percent.
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.
The 2016 county-by-county health rankings for Kentucky, which are put together by the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin, reported that in the county with the lowest uninsured rate, 10 percent of the population under age 65 was uninsured. In the county with the highest uninsured rate, 24 percent of the population was uninsured. However, these statistics come from 2013 data, before the Affordable Care Act had fully taken effect.
How has Obamacare helped KY?
In 2014, Kentucky saw the nation’s second-largest drop in uninsured rate, according to Gallup’s findings. Before the ACA took full effect in 2014, the state’s uninsured rate was 20.4 percent. By the end of 2014, it dropped to 9.8 percent. Only Arkansas, with an 11.1 percentage point decrease, experienced a greater decline in its uninsured population.
Kentucky remained second to Arkansas among states with the largest reduction in percentage of uninsured; its uninsured population was 7.3 percent by the end of 2015. The national uninsured rate was 11.7 percent. Seven of the 10 states whose uninsured rates have declined most have both expanded Medicaid and implemented a state-run marketplace—this includes Kentucky.
When the 2017 open enrollment period begins November 1, 2016, Kentucky’s state-based exchange, Kynect, will conduct enrollment through HealthCare.gov. Kynect has been widely considered among the country’s most successful state-run exchanges. However, Gov. Matt Bevin, who took office in 2015, is transitioning it to a federal exchange. It will be considered a state-based exchange until this transformation is complete.
Rates and carriers for 2017 open enrollment
Replacing Kentucky’s health insurance enrollment platform to HealthCare.gov is not the only change for 2017. Wellcare and UnitedHealthare will completely exit the Kentucky exchange. United will also cease to offer individual plans away from the exchange, but will continue to sell small group plans outside of it.
The remaining five carriers include:
- Anthem BCBS
- CareSource Kentucky
- Bluegrass Family Health (Baptist Health)
Kentucky enrollment in qualified health plans
Nearly 83,000 Kentucky residents signed up for qualified health plans (QHPs) during the ACA’s first open enrollment period in 2014. 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.
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 are 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.
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 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 has been 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.
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. The vast majority of Kentucky, 70 percent, would prefer Bevin keep the state’s expanded Medicaid program as-is.
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.
From 2013 to May 2016, Kentucky Medicaid enrollment increased 100 percent, the biggest change nationwide. Nevada saw the second-biggest change with a 83 percent increase. Enrollment in Medicaid and CHIP continues throughout the year, which means this number is constantly changing.
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.
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.
KY Medicare enrollment
Kentucky has the highest percentage of Medicare recipients listed as disabled: 25 percent. The other 75 percent qualify for Medicare based on age alone. Medicare pays about $8,891 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 25 percent of Kentucky beneficiaries selected Medicare Advantage in 2015. Nationally, 31 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.
Kentucky’s state-based reform legislation
Here’s what’s happening legislatively in Kentucky with healthcare reform at the state level: