As a legal aid attorney in Eastern Kentucky, I spent a lot more time giving financial advice to people my parents’ age than I did in a courtroom. If you think a millennial giving advice to baby boomers sounds uncomfortable, it is. The conversations often started with unforeseeable medical debt and ended with me filing their bankruptcy or defending their foreclosure suit.
Where did they go wrong? Nowhere really, unless not being able to afford health insurance counts. That said, it could have been worse.
Kentucky expanded Medicaid in 2014 to include adults living below 138% of the poverty line; that’s less than $17,500 per year for an individual and less than $35,600 for a household of four. Thanks to expansion, nearly half a million Kentuckians have new access to health coverage, reducing our uninsured rate by half. More people with insurance means less unpaid medical bills means less bankruptcies and foreclosures. Sounds good, right? Apparently not to our governor.
I now work on health policy issues at Kentucky Equal Justice Center (KEJC) and joined our co-counsel, the Southern Poverty Law Center and the National Health Law Program, in a D.C. courtroom. Together, we represent 15 courageous Kentuckians as they challenge Gov. Matt Bevin’s plan for Medicaid. The plan, called Kentucky HEALTH, would raise costs, reduce benefits and add new reporting requirements for people to get and keep Medicaid. Twice now, a federal district court has struck down the governor’s plan, but the Bevin administration keeps funneling state resources into defending it.
We’ll see what the D.C. circuit court says about whether Kentucky HEALTH is legal. In the meantime, I’ve spent months trying to understand the reasoning behind the plan. Spoiler alert: I still don’t get it.
According to Gov. Bevin, the work requirements in his plan are necessary because “hundreds of thousands of able-bodied adults” enrolled in Medicaid aren’t working.
But the evidence tells a different story. According to a study sponsored by the state of Kentucky, the vast majority of Medicaid beneficiaries who can work are working. They just aren’t making enough to afford health insurance. And at $17,500 per year (that’s working for minimum wage a little more than 40 hours per week), it’s easy to see why.
Rather than promoting work, work requirements simply create more paperwork for people who are already busy working. Ask Arkansas. In 2018, Arkansas tried work requirements. In the first sixth months, 18,000 adults lost their health insurance. A study in the New England Journal of Medicine revealed that most of them met the work requirement or qualified for an exemption. They just got lost in the bureaucratic reporting process.
Gov. Bevin knows that his plan will mean a lot Kentuckians will lose their health insurance. His original proposal estimated 95,000. But according to the governor, that’s OK because we can’t afford Medicaid expansion anyway.
Again, the evidence says otherwise. Far from being too expensive, Medicaid expansion is an incredible deal for our state, particularly for our rural hospitals. Just ask Tennessee. Hospitals there are closing because Tennessee refuses to expand Medicaid, leaving rural hospitals with a lot of unpaid bills from patients who can’t afford to pay. Meanwhile, many Kentucky hospitals have stayed open because of the influx of federal Medicaid dollars.
I say “federal dollars” because for every dollar Kentucky spends on Medicaid expansion, the federal government puts in nine. In a state that ranks 47th in the nation for overall health outcomes, not to mention 50th in cancer deaths, we can’t afford to leave federal money on the table for healthier states.
So here I am, still stumped. I haven’t figured out how spending state money on unnecessary bureaucracy that kicks Kentuckians off their health insurance is better than using federal money to improve Kentucky health. But while we wait for the courts to rule on the plan, I’ll still be here telling people to pay their mortgage before their medical bills and helping them navigate the Medicaid bureaucracy.
Betsy Davis Stone is the Health Law Fellow at Kentucky Equal Justice Center, an advocacy nonprofit dedicated to addressing issues that affect low-income Kentuckians. Prior to this role at KEJC, Stone worked as a legal aid attorney. She can be emailed at firstname.lastname@example.org.