Kentucky voters elected Republican businessman Matt Bevin as their new governor on Tuesday, which sadly means a whole lot of people are probably about to lose their health insurance. The Tea Party favorite has promised to roll back pieces of the Affordable Care Act that have helped slash Kentucky's uninsured rate by more than half according to Gallup, the biggest drop of any state in the country since the law's major planks were implemented.
Oh well. 'Twas a happy story while it lasted.
How much Bevin actually plans to upend health reform in Kentucky is still a bit unclear. He has promised to abolish the state-run marketplace, Kynect, and move customers to the federal exchange, which frankly shouldn't be that huge a deal. Much more importantly, he has vowed to reverse, or at least significantly curtail, the state's expansion of Medicaid, which extended health coverage to more than 400,000 low-income residents.
John Oliver aired a pretty funny segment skewering Bevin's contradictory statements on what, exactly, he would do with the Medicaid expansion. But by now he has pretty clearly stated that he intends to seek a section 1115 waiver, similar to what states like Indiana and Pennsylvania have received, that would allow Kentucky to "experiement" with a more restrictive version of the program, probably involving more private insurance options. He explained his thinking at length during a September interview with Lousiville's NPR affiliate, WFPL.
Host: You said you're going to draw down the number of people on Medicaid in the state. What's your plan for that?
Bevin: Of necessity it will have to happen. Because there literally is no ability for us from a budgetary standpoint to afford 25 to 30 percent of Kentuckians on Medicaid ...
Of necessity we must scale this back. The way you do this is just to make it not as accessible for folks going forward. There’s re-enrollment for Medicaid, just as there is for any number of other programs, etc. So we would not allow people to re-enroll, going forward, at 138% of the federal poverty level. Is that done immediately? That will be done in a uniform fashion because you can’t just simply end it on day one. You have to of necessity start to do this as people enroll anyhow. So we are going to scale it back. We cannot afford to do otherwise.
Given that states have typically sought 1115 waivers as a condition for joining the Medicaid expansion, rather than an ex post facto maneuver to change to it, it'll be interesting to see what sorts of alterations Bevin manages to make. Big picture, though: It doesn't quite look like the end of Obamacare in Kentucky, as some of the law's supporters seem to fear. Just the beginning of a stingier, maybe less effective version.