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Kentucky Bet On Medicaid Expansion Under Obamacare. Now It Has A Lot To Lose

Sarah Fentem and Lauren Chapman
Side Effects Public Media

As Kentucky Senator Mitch McConnell works to drum up votes for his health care bill in Congress, people in his home state worry about what they could lose if the bill passes.

Kentucky expanded Medicaid in 2014 under the Affordable Care Act and nearly half a million residents gained coverage. That’s among 14.4 million people around the country who’ve gotten Medicaid coverage since the ACA passed. The funding for that will be rolled back by 2024 if the Senate's proposed health care bill passes, and with further proposed changes to Medicaid funding, 15 million Americans are predicted to lose Medicaid coverage in the next 10 years.

These proposals are frustrating to people who worked hard to enroll residents in Kentucky’s Medicaid expansion, originally called KYnect—people like Cara Stewart, a health fellow at the Kentucky Equal Justice Center, a nonprofit legal advocacy group.

“Faces flash in front of me and I don’t know what I would tell them,” she says. She recalls working to help uninsured people find coverage.

“It was so life-changing for people to know that they were valued by their community, that they too mattered and that were eligible for health care,” she says. “It’s hard to imagine what it would be like to go back to people not having coverage.”

Emily Beauregard of the advocacy group Kentucky Voices for Health worries losing the progress made in increasing insurance coverage in the last three years.

“It’s been a tremendous change for Kentucky and for our economy, but also just been life-changing for the individuals and the families that have gotten coverage,” she says.

Now about half of those people risk losing their coverage, according to an analysis of the House version of the GOP plan. This could hit the state hard, and the people who worked to help their fellow citizens get enrolled are unhappy.

Insured…for now

One of those newly covered Kentuckians was Marie Kirtley, a 48-year-old breast cancer survivor who lives in rural Corydon, Kentucky. After her husband lost his job in 2013, she went without health coverage—paying out of pocket for biannual cancer screenings—until she found out she could sign up for Medicaid.

Marie works full-time caring for her adult son, Steven, who has Fragile X Syndrome. He’s unable to control his verbal and motor skills and can’t live on his own. He’s been on the waitlist for a group home for over a decade but for now the state of Kentucky pays Marie a small monthly income to care for him, and that keeps her too busy to get a job that could provide health insurance.

Marie was on her husband’s employer’s health plan until 2013, when he had to leave his oil field job because of injuries. Between her husband's injuries and Marie’s cancer screenings, the bills started piling up. Last year the couple filed for bankruptcy.

“We gave up our home first; we lost our truck; we couldn’t pay our bills,” recalls Kirtley. 

Credit Samantha Horton/Side Effects Public Media
Marie Kirtley is a full-time caretaker for her son Steven.

Even after bankruptcy, Marie’s income from being her son’s caregiver put them just above the cutoff for Medicaid eligibility at the time.

But after Kentucky expanded Medicaid in 2014, they were eligible. Early this year, the family finally got on a Medicaid plan.

It was a relief. It is also Kirtley’s only option for health coverage, since getting a job with an employer-sponsored plan is not possible for her.

“Until I can get my adult son into a home of his own, then where am I going get a job?” says Kirtley. “[It] looks like I’ll just stay at home and go by that dreaded term, that we all kind of misunderstand, of living off the government.”

Many people who got insurance under the Medicaid expansion were working hard at poorly paid jobs, says Nibby Priest, an independent insurance agent in Henderson, Kentucky who helped sign people up for KYnect.

“These were people that were not just sitting at home on the couch doing nothing. These were people that were serving us every day,” says Priest. “People that were working at the Cracker Barrel or Thornton’s. They were just having a hard time making ends meet.”

No easy answers

But if Congress votes in the proposed GOP health bill, many of these people will be left without coverage. And, no matter what happens in Congress, Kentucky Governor Matt Bevin has indicated he hopes to scale back some of the state’s Medicaid services to save money. The state's portion of its Medicaid costs are projected to increase from $74 million in fiscal year 2017 to an estimated $176.7 million in fiscal year 2018. 

But changes to Medicaid won’t just affect the uninsured. The Commonwealth Fund released a study earlier this month reporting deep cuts to coverage could lead to about 1 million jobs lost by 2026--a majority  of those from the healthcare sector .

Credit Samantha Horton / Side Effects
Side Effects
Cara Stewart and Emily Beauregard

“With reduced subsidies, with Medicaid expansion being cut, I just think the whole state will hurt,” says Kentucky Voices for Health’s Emily Beauregard. “Our entire economy will feel this,” she says.

In Corydon, Marie Kirtley is afraid of losing Medicaid coverage because it helps her pay for cancer screenings.

“I need to stay on top of my health. I need to know if something is wrong,” says Kirtley. “I don’t need to die last minute, unexpectedly.”

She’s not just thinking of her own health; she also has her disabled son to think about.

“So I’m just stuck between a rock and a hard place," she say. "There are no easy answers. So it’s one day at a time. Today I have health insurance.”

This story was produced by Side Effects Public Media, a reporting collaborative focused on public health.