If Republicans in Congress move forward with their plan to replace Obamacare, Kentucky Governor Matt Bevin’s ideas for the future of the program could also go up in smoke.
About 440,000 people were added to the state's Medicaid rolls as a result of former Gov. Steve Beshear's executive order to expand the program in 2013, making more people eligible for benefits under the Affordable Care Act.
Bevin has asked the federal government to allow his administration to make changes to Kentucky's traditional and expanded Medicaid program — tweaking benefits, requiring people to pay small, monthly premiums and ultimately trimming about 86,000 people from the program.
But Bevin's plan still accounts for an expansion of Medicaid and Congress is considering phasing out funding for expansions over the next three, five or seven years.
That means Kentucky would have to shoulder more of the costs, said Dustin Pugel of the progressive Kentucky Center for Economic Policy.
“Our share would increase from 10 percent to 30 percent, it would triple," Pugel said. "It would be about a $405 million increase for us to be able to keep it each year."
That’s $405 million to keep the current version of Kentucky’s Medicaid expansion according to the left-leaning Center on Budget and Policy Priorities.
Even though Bevin’s proposal would pare back coverage and could cost less, it would still technically be an expansion of the traditional Medicaid program.
But Congress’ planned overhaul of Obamacare could wreck the economics behind Bevin’s plan. Kentucky would have to shoulder more of the costs — precisely the opposite of what Bevin is trying to do.
As Robin Rudowitz with the Kaiser Family Foundation said, if the money that made that expansion possible is phased out, Kentucky would have to figure out how to fund the programs with less money, or get rid of the expansion altogether.
“Do they maintain that coverage and fill that gap in federal financing with their own state dollars," said Rudowitz. "So for most states that have to pass a balanced budget, that would mean increasing taxes, cutting funds from another state program to back-fill those federal dollars."
Bevin has argued that Kentucky can’t afford expanded Medicaid in its current form. He predicted last summer that his proposal would save about $330 million over five years.
And he said if the federal government doesn't approve his waiver, he’ll just get rid of the Medicaid expansion altogether.
But there’s no word on what will happen if Bevin gets what he’s asked for, but loses the federal money to pay for it.
Under President Trump’s administration, it seems like Bevin’s proposal has a good chance of being approved. Some of the people who helped craft Bevin’s waiver plan now work in Trump’s health cabinet.
Doug Hogan, a spokesman for the state health cabinet, said they feel optimistic about the waiver's approval, but there are too many uncertainties to speculate on the impact of Congress’ Obamacare repeal plan.
"Nothing we have seen presented so far has caused us to pause in pursuit of the Kentucky HEALTH waiver," Hogan said.
Meanwhile in Washington, Senate Majority Leader Mitch McConnell is trying to craft an Obamacare replacement bill with only Republican votes.
McConnell can only afford to have two Republicans vote against the measure, with Vice President Mike Pence casting a tie-breaker.
And for the 440,000 Kentuckians who gained insurance under Medicaid, the future of their health insurance is somewhere in between Frankfort and Washington.
