GOP gubernatorial candidates agree on Medicaid expansion's sustainability in Kentucky

11/16/2014 02:21 PM

Kentucky Gov. Steve Beshear’s decision to expand Medicaid eligibility has put the state on an unsustainable path when the federal government ratchets down its share of the bill beginning in 2017, Republican gubernatorial candidates James Comer and Hal Heiner say.

Beshear’s executive order, made possible through the Affordable Care Act, has added more than 425,000 recipients to Kentucky’s Medicaid rolls, and Washington, D.C., has paid 100 percent of the costs for the newly eligible. Beshear based his decision in part on the projected $15.6 billion economic impact once the program is fully implemented in fiscal year 2021.

But Louisville real estate developer Hal Heiner said Friday the state hasn’t shown signs of economic progress after the first year of expanded Medicaid eligibility.

Kentucky will begin paying a portion of the expenses in 2017 — the second year of the next governor’s administration — and 10 percent of the bill from 2020 on. The Associated Press reported Thursday that state House Republicans expect the expansion to cost about $250 million between 2017 and 2020, with 2017’s bill totaling up to $90 million.

Unless the state can afford the newly insured low-income residents, there’s no way Medicaid expansion can survive in Kentucky, Heiner said.

“We’re signed up for an expansion that we have absolutely no way to pay for, and unless we grow this economy in Kentucky, we’ll not be able to continue with it,” he said after addressing the Kentucky Hospital Association’s conference.

“Even if there is, we all want people to be healthy, but the plan that we’ve signed up for, the federal plan, has no level of personal responsibility, and if you look around the country, the best governors are looking at ways to actually improve health care, to reduce overall costs by building incentives, by building premiums into their Medicaid. We didn’t do that in Kentucky.”

Comer, Kentucky’s agriculture commissioner, said he would wait to see whether Congress acts on the new federal health law with U.S. Senate Majority Leader-elect Mitch McConnell handling the Senate’s agenda. McConnell, who won reelection by more than 15 points on Nov. 4, campaigned on repealing the Affordable Care Act, dubbed Obamacare by detractors, “root and branch.”

With nearly a quarter of the state’s residents now on Medicaid, Comer said the program is unsustainable in Kentucky.

“When Gov. Beshear greatly expanded the Medicaid program in the state, the federal government subsidized if for the first three years,” Comer said Friday before addressing the Kentucky Hospital Association’s conference. “Well lucky for him that subsidy runs out right after he leaves office, so the next governor is going to have to pay that extra 5 to 10 percent that the federal government was picking up the tab on.”

He pointed to a Courier-Journal report Friday that said the state’s rural hospitals are struggling under the Affordable Care Act and noted Clinton County Hospital filed for bankruptcy last week.

“We have a problem on our hands with access to health care, especially in rural areas, and then here in Louisville we have a huge problem between the two major hospitals here,” he said. “So the next governor’s going to have his hands full with respect to health care.”

Kentucky’s growing heroin epidemic is another key health issue in the state as lawmakers look for a way to combat fatal overdoses and trafficking.

The General Assembly came close to a compromise in this year’s session, though a resolution eluded legislators in the session’s final minutes. Controversial aspects of the bill, such as charging heroin dealers with homicide in overdose deaths and creating needle-exchange programs, were the largest areas of disagreement among lawmakers.

Legislative leaders have signaled a renewed effort at handling the burgeoning drug problem in next year’s session, and both GOP candidates say they hope a solution is reached.

Heiner said the legislature needs to address the issue in a three-pronged approach to suffocate the heroin-trafficking enterprise.

“Our law-enforcement agencies need to have the same tools at their disposal that the federal government has and that law enforcement in other states have,” he said. “It’s simply too easy to be in the business of drugs in Kentucky. We need to increase our rehab efforts. You know, a 90-day program for rehab has almost a 0 percent success rate, so we need longer rehab programs in Kentucky, and we need a statewide education program for our young people.”

Comer said he’s “very proud” of his running mate, Republican state Sen. Chris McDaniel of Taylor Mill, because he will be the lead sponsor of a heroin bill that will attempt to tackle the issue through rehabilitation, education and stiffer penalties against dealers.

“He’s doing an outstanding job,” Comer said of McDaniel. “He’s a leader in Kentucky, he’s a leader in the General Assembly, and that’s going to be his issue, and I look forward to working with him once it’s passed to be able to help find a solution to the heroin epidemic that we have throughout Kentucky.”

Kevin Wheatley

Kevin Wheatley is a reporter for Pure Politics. He joined cn|2 in September 2014 after five years at The State Journal in Frankfort, where he covered Kentucky government and politics. You can reach him at or 502-792-1135 and follow him on Twitter at @KWheatley_cn2.


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