Bills on kynect, Medicaid expansion sent to House floor after party-line votes in House Health and Welfare Committee

03/17/2016 11:50 PM

UPDATED FRANKFORT — A partisan battle over the pieces of the Affordable Care Act implemented by Gov. Steve Beshear is brewing in Kentucky’s General Assembly, with a pair of bills heading to a floor debate in the House.

The House Health and Welfare Committee passed bills along party-line votes that would codify the state’s health-benefit exchange, kynect, and expansion of Medicaid eligibility to the fullest extent under federal law, or 138 percent of the federal poverty level.

Beshear enacted both optional provisions of the federal health law, commonly known as Obamacare, by executive orders in 2012, side-stepping the legislature and angering Republican lawmakers in the process.

Gov. Matt Bevin, the second Republican elected governor since 1971, has taken steps to shutter kynect and transition Kentuckians to the federal exchange and has formed a work group to draft CMS waivers for both expanded and traditional Medicaid.

Partisan tensions on both subjects bubbled over in the health panel, particularly over costs for the exchange and its enactment via executive order. HB 6, legislation on Medicaid expansion, was voted out without debate.

“Let me just say that I think most people in this room, most people in Kentucky pay federal taxes as well, so this whole notion that there’s a great federal money tree in which we can go and pick off of and build things is just not correct,” said Rep. Robert Benvenuti, R-Lexington.

Kentucky has received nearly $290 million in federal grants to launch kynect, with about $57 million in unused dollars due back to Washington since Bevin’s decision to take the state’s exchange offline.

The House’s version of the budget sends $23.5 million in each fiscal year from the Kentucky Access Assessments Funds for kynect, with $20.4 million of that budgeted in the first fiscal year of the biennium and $8.2 million budgeted in the next.

That fund is filled with a 1 percent assessment on insurance premiums, and House budget writers directed that $47 million appropriation to the underfunded Kentucky Teachers’ Retirement System and Kentucky Employees Retirement System for most state workers should the health exchange be decommissioned. The House also limited the amount of the Kentucky Access appropriation that can be used to take down kynect in the last year of the biennium to $1.6 million.

Federal dollars budgeted for the exchange total $22.7 million in the first year of the biennium and $9.2 million in the second.

For Rep. Darryl Owens, it’s money well spent.

“I’m not saying its a money tree,” said Owens, a Louisville Democrat who sponsored both HB 5 and HB 6. “I’m just saying this is a grant that the federal government gave to states if they wanted to develop their own system, and I think the thing we miss when we talk about that is we have a great system. We have the best system in the country.”

Supporters cited the state’s sharp decline in uninsured rates, drops in emergency room visits, upticks in dental and cancer screenings, and increased access to substance abuse services in their arguments to keep kynect.

They also noted that Bevin’s administration has launched Benefind for Medicaid and other assistance programs, which is budgeted at $17.1 million in restricted and federal dollars each year in the latest version of the two-year spending proposal.

“Based on Secretary Glisson’s testimony on March 2, it sounds like they were estimating that it would cost about $11 million for qualified health plan enrollment, and that would be $11 million to Kentucky to have those qualified health plans on the federal exchange,” Emily Beauregard, executive director of Kentucky Voices for Health, said in reference to Cabinet for Health and Family Services Secretary Vickie Yates Brown Glisson.

Doug Hogan, interim CHFS communications director, said in a statement Thursday afternoon that the cabinet is still processing costs for Benefind, which aren’t associated with the transition to the federal exchange.

“Contracts were awarded, the system was designed, built and workers were trained on how to operate the system all during the previous administration,” Hogan said in an email. “The only thing that occurred during our administration was taking the system live.

“In the current year, Kentucky is spending $35 million to operate kynect for an average enrollment of 85,000 QHP enrollees. When we transition to next year, if enrollment stays about the same, the Federal Government will collect about $5M for their operational cost, and the state will collect around $2M to conduct the state based activities.”

Senate President Robert Stivers, R-Manchester, has said he would welcome a legislative debate on the exchange and Medicaid expansion, a sentiment echoed by Rep. Tim Moore, R-Elizabethtown.

“Something of this magnitude that you are now coming to us and clamoring for us to endorse was never put in place in the first place by legislative process, by legislative voting to reflect the will of the people,” he said.

House Speaker Greg Stumbo, D-Prestonsburg, said he expects both HB 5 and HB 6 will receive floor votes.

“They’re worthy of debate, and people need to know the facts, and, you know, it was a program that was working,” he told reporters after the House adjourned. “It was working very well for a lot of Kentuckians.”

“There’s never really been a debate on this issue, you know?” he continued. “There’s not been a true letting of the facts, if you will.”

Despite slim prospects across the Capitol, Stumbo wouldn’t call the upcoming votes on federal health law provisions implemented by the recently departed Democratic governor, who also chairs a nonprofit launched in February to protect those moves, political statements.

“We pass a lot of things that can’t pass the Senate,” he said. “They pass a lot of things that can’t pass the House.”

Correction: A previous version of this report said that Hogan did not respond to a request for comment Thursday.


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