Kentucky: State legislature may help Gov. Bevin shoot 450,000 hostages

Last year, Republican Governor of Kentucky Matt Bevin, who had campaigned heavily on a promise to repeal ACA Medicaid expansion altogether, partly changed his tune once he actually took office. Instead of kicking all 450,000 low-income Kentucky residents off the program completely, he first imposed an absurdly insulting and cumbersome "frequent flyer"-style program:

Kentucky is moving closer to an overhaul of the state's Medicaid program Bevin has said is aimed at controlling costs and encouraging more personal responsibility in consumers, changes that include elimination of basic dental and vision benefits for most "able-bodied" adults who instead would have to earn them through a "rewards" program.

..."It is expensive to go to a dentist," he said. "These changes are just ludicrous."

...Proposed changes include monthly premiums, co-payments for services, mandatory work or volunteer activity to maintain Medicaid coverage and "lock-outs" of coverage for up to six months for some who fail to pay premiums. The state proposal also includes a "My Rewards" account where people can accumulate points for activities such as passing a GED exam, completing job training or completing wellness activities such as stop-smoking classes, points that go toward the purchase of services such as dental or vision care.

But Medicaid members also would have points deducted from their rewards account for infractions such as failing to pay premiums or "inappropriate" use of emergency rooms up to a negative balance of $150.

The cornerstone of Bevin's proposal, of course, was his attempt to add draconian "work requirements" to Medicaid expansion enrollees...while also threatening to go back to his original plan to kill off the program altogether if he didn't get his way:

Bevin issues ultimatum: If courts block Medicaid plan, half million Kentuckians will lose care

Gov. Matt Bevin has issued an executive order that would strip Medicaid coverage from nearly half a million Kentuckians should his proposed overhaul of the federal-state health plan be struck down in court.

No one has filed a legal challenge to Bevin's changes to Kentucky's Medicaid program that federal authorities approved Friday.

...The order Bevin filed Friday directs the secretary of the Cabinet for Health and Family Services and the Medicaid commissioner to "take necessary steps to terminate Kentucky's Medicaid expansion" if any part of his plan is struck down in court and all appeals are exhausted.

Note that as of the date of this article (1/16/18), there were no court challenges to Bevin's work requirement proposal...but that quickly changed, and sure enough, by June, his waiver was shot down in court:

The Trump administration’s approval of Kentucky’s strict Medicaid work requirement, set to go into effect July 1, was vacated on Friday by a federal judge in Washington D.C. and sent back to the Department of Health and Human Services for reconsideration.

In a sweeping ruling striking down the entirety of Kentucky’s Medicaid waiver, U.S. District Judge James Boasberg sided with the dozen-plus low-income Kentuckians who had challenged the new rules, and said that the Trump administration acted in an “arbitrary and capricious” manner by approving them.

“The Secretary never adequately considered whether Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid,” Boasberg wrote, later adding that HHS “entirely failed to consider Kentucky’s estimate that 95,000 persons would leave its Medicaid rolls during the 5-year project.”

This victory for common sense and decency was short-lived, however, since five months later...

.@CMSGov just re-approved Kentucky’s #Medicaid waiver. https://t.co/2Q16AKQoLS

— Dustin Pugel (@Dpugel) November 21, 2018

...which, of course, led to a second lawsuit, kicking the whole process off again:

Sixteen of Kentucky’s Medicaid recipients are suing the federal government to stop Gov. Matt Bevin from adding work requirements, premiums, coverage lock-out periods and reporting duties for able-bodied adults in the state’s $9.7 billion-a-year Medicaid program.

A similar group of plaintiffs successfully blocked Bevin’s Kentucky HEALTH initiative last June. U.S. District Judge James Boasberg in Washington, D.C., halted the roll-out, ruling that the federal government “never adequately considered whether Kentucky HEALTH would, in fact, help the state furnish medical assistance to its citizens, a central objective of Medicaid. This signal omission renders (the government’s approval) arbitrary and capricious.”

In November, the U.S. Centers for Medicare and Medicaid Services re-approved Bevin’s Medicaid waiver proposal with minor changes, prompting the amended lawsuit that was filed Monday, again in Boasberg’s court in Washington. Bevin has tried unsuccessfully to get the legal battle moved to Kentucky.

Well, Matt Bevin may be a horrible person, but he's nothing if not tenacious. It looks like he's decided to revert back to his original threat to shoot the hostages after all...this time with a little help from his friends in the GOP-controlled state legislature. via the Kentucky Equal Justice Center:

EMERGENCY: Legislature Poised to Empower Bevin to Take Health Coverage from 450,000 Kentuckians

...The law in Kentucky requires the Governor and his administrators to “take advantage of all federal funds that may be available for medical assistance.”

...Rep. Moser’s floor amendment (which you have called to oppose already, right?) would make that policy discretionary.

Why does this matter?

Last summer, Governor Bevin’s first attempt to impose harmful changes to Kentucky’s Medicaid Program lost in court. Now, he’s trying again and has said that if he loses this case he will unexpand Medicaid, stripping Medicaid coverage from hundreds of thousands of Kentuckians.

Changing the state’s policy from pursuing “all federal funds” to one where the Governor has discretion to say “yes” or “no” to federal funds will make it easier for Governor Bevin to make good on his dangerous promise to take away health coverage from almost half a million Kentuckians.

This last-minute amendment would empower the Governor to strip health coverage from 450,000 Kentuckians. Instead of legislators being responsible for deciding what health policy makes sense for their constituents and neighbors, Kentucky lawmakers would pass that responsibility on to a single person, a person who has already threatened to take away health coverage from people who need it if he doesn't get his way.

Until now, Governor Bevin has been waving an unloaded gun when threatening to end Medicaid expansion. With this bill, the Kentucky lawmakers would give him a bullet.

Given Bevin’s promise to end Medicaid expansion if he loses in court, a vote for SB 167 as amended by Rep. Moser’s Floor Amendment is a vote to take health care coverage away from 450,000 Kentuckians.

Last week, legislators in Wyoming and West Virginia decided not to follow Bevin’s lead and declined to impose a work requirement on people getting their health insurance through Medicaid. Instead of doing the same, the Kentucky legislature is poised to give Bevin the power to end Medicaid expansion completely.

The phone number is 1-800-372-7181 and the bill is Floor Amendment 1 to Senate Bill 167. Tell the legislators not to give the Governor the power to make good on his dangerous threat to end Medicaid expansion in Kentucky.