GOP lawmaker says Ky. should have gone the route of Arkansas with Medicaid expansion

05/16/2013 04:14 PM

The decision to expand Medicaid coverage to more low-income families won’t necessarily increase access to health care and could increase the inefficiencies in the current system, said Rep. Robert Benvenuti, a freshman Republican from Lexington.

Benvenuti, a lawyer who worked from 2004-2007 as inspector general of the state’s health cabinet that oversees Medicaid, said he disagreed with Gov. Steve Beshear’s move last week to accept the expansion, which will cover 308,000 uninsured Kentuckians who earn less than 138 percent of the federal poverty rate. That’s about $31,000 for a family of four.

But unlike other critics, who slammed the decision for its potential cost to the state once the federal government stops paying the full freight in 2017, Benvenuti offered alternative suggestions.

For instance, he said he would have rather seen Kentucky expand Medicaid the way Arkansas plans to. That state received a waiver from the federal government to use the money for Medicaid expansion to pay private insurers to cover those uninsured who fall between the poverty line and 138 percent of the poverty rate.

And he said Medicaid, as it’s structured now, does little to change how people use — or misuse — the health care system.

“All this program does is say, for example, ‘Here is a ticket. Here is a way into the system.’ It doesn’t provide access,” he said noting that only physicians and hospitals can provide access to health care. (1:30 of the interview)

“So you have a Cadillac style program that quite frankly, nobody could go out and afford if they went out into the private market because it’s an unrealistic program. And on top of that, because it was meant for a very small (and) specialized population of the truly vulnerable, there’s no patient responsibility. There’s no skin in the game,” Benvenuti added (2:15).

About half of the $6 billion total budget in Medicaid covers health costs for about 120,000 of the most severely disabled and most ill Kentuckians who need the most extensive and expensive care. The other half of the program’s budget covers about 700,000 Kentuckians — adults and children — whose family income is at the poverty rate or below.

For the latter group, Benvenuti said he’d ideally like to see the program charge a nominal copay or deductible.

“If you did that, then what you would have, is you’d create a health care system that ultimately was provider friendly and patient focused and value driven,” he said (4:30).

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