Questions about the Ky. Medicaid expansion

The Associated Press

FRANKFORT (AP) — Kentucky Democratic Gov. Steve Beshear expanded the state’s Medicaid program under the Affordable Care Act. The federal government pays for 100 percent of the expansion until 2017, when state governments begin sharing the cost. Kentucky’s state legislature will debate how to pay for that beginning in January.

What were the original enrollment and cost projections for Kentucky’s expanded medicaid program?

In 2013, one year before the start of Medicaid expansion, Kentucky officials estimated they would add 147,634 people to the state’s Medicaid program in the first year. By 2020, they predicted the state would have 187,898 new enrollees. By 2017, state officials estimated it would cost $33 million to pay for these people, plus another $74 million in 2018.

What really happened?

Kentucky’s Medicaid expansion was wildly popular. More than 310,000 people enrolled in the first year, more than double the original estimate. State officials have not had to pay for this yet. But a state study from earlier this year projected it would cost the state $119 million to pay for this new population in 2017. That includes paying for people who were eligible for the expansion as well as people who were already eligible and signed up because of the publicity.

How will the state pay for this?

State legislators and the next governor will have the final say. Gov. Beshear says the state will have plenty of money to pay for the expansion. He points to a study from the Deloitte consulting firm that shows the state will spend $1.1 billion on Medicaid expansion by 2021 but will generate $1.7 billion in savings and new revenue over the same time period. Republicans are skeptical, pointing out the state also has another multi-billion hole to plug with its troubled pension systems for state workers and teachers

Will the next governor have a role in deciding the fate of the expansion?

Yes. Gov. Beshear cannot seek re-election because of term limits. Kentucky voters will elect his successor in November, and he will take office in December. The governor controls the state’s Medicaid program and writes its budget. And with Democrats controlling the state House of Representatives and Republicans controlling the state Senate, the governor has the power to veto portions of the budget he doesn’t agree with.

Where do the candidates for governor stand on the issue?

Republican nominee Matt Bevin has said he would reverse the Medicaid expansion and dismantle kynect, the state-run health insurance exchange. He would likely do it slowly, probably over a year. He says his administration would focus on creating jobs for people so they would not have to rely on government assistance. Democratic nominee Jack Conway has vowed to support kynect and the Medicaid expansion. He says his administration would not strip health insurance from hundreds of thousands of people.

The Associated Press

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