Expanded Medicaid Continues Showing Progress in Kentucky
By Ben Chandler
Foundation for a Healthy Ky.
Improving health takes time. Almost everyone has struggled to improve their health in one way or another – whether it’s trying to achieve a healthier weight, recover from a serious illness, reduce anxiety and stress, or overcome an addiction – and we don’t expect overnight results. But when we find something that truly helps, we know we ought to stick to it and see it through to real results.
Expanding the Medicaid program in Kentucky to cover more low-income, and predominantly working, people is truly making a difference in our population’s health, and we ought to stick to it. I’m pleased that Gov. Bevin is planning to keep expanded Medicaid in the Commonwealth, while also trying to make the program more cost efficient, and hope federal law will continue to allow newly insured Kentuckians to retain their Medicaid coverage. Kentucky needs to see this effort through.
The Commonwealth faces unique challenges that affect our health. High poverty rates are among the social issues that lead our health statistics to trail most other states, as well as the country as a whole. We have the highest cancer death rate in the nation. Our rates of heart disease, diabetes, poor mental health, and drug overdoses are among the worst. More Kentuckians are obese, and more smoke, than residents of almost every other state. Our life expectancy is not improving at the same pace as other states; eight Kentucky counties had the largest decreases in longevity in the nation from 1980 to 2014.
After Medicaid expansion, however, the needle is beginning to move.
The rate of uninsured Kentuckians dropped by more than half, from 13.6 percent to 6.1 percent, after expansion went into effect in January 2014, according to independent research commissioned by the Foundation for a Healthy Kentucky. We now have one of the lowest uninsured rates in the nation.
What’s more, the number of Kentuckians reporting that they have a usual source of health care jumped more than seven points to nearly 90 percent from 2012 to 2015. This is an important indicator, and has been found in some studies to be more important to health outcomes than insurance rates. Also, significantly fewer people across the state now say that they have delayed or gone without needed medical care due to the cost.
Newly covered individuals are using their coverage in ways that health experts and advocates say can lead to healthier lives. For example, our study found that expanded Medicaid has covered hundreds of thousands of health screenings – such as tests for breast cancer, colon cancer and diabetes – for low-income Kentucky adults who otherwise likely couldn’t afford them.
Getting recommended tests such as colorectal cancer screenings and mammograms helps prevent chronic disease and allows for earlier treatment. The screenings save lives. They also save money for Medicaid and the rest of the health care system that would otherwise pay the price of late-stage and crisis care for people who were forced to put off medical visits until they got too sick to delay any longer.
Our research shows that one group that benefitted most from the upgraded Medicaid program has been younger adults, aged 19 to 34. Although this tends to be the healthiest population, without insurance, they often don’t use the preventive services. Thanks to Medicaid, they have a better chance than ever before to prevent and, when needed, manage chronic disease, disability, and other negative health outcomes. Medicaid also has been found to protect people from bankruptcy, and research shows that lacking coverage and access to care has a negative impact on life expectancy. Losing coverage can force Kentuckians into a life-or-death situation.
Health coverage and access to care also benefit local hospitals. By medical centers’ own reporting, they are seeing reductions in charity and self-pay charges for patients without health insurance. In fact, uncompensated care dropped 67 percent after Kentucky overhauled Medicaid, representing nearly $800 million in avoided losses as of 2015. This is enough to make the difference for many institutions between staying open and collapsing in bankruptcy.
Finally, there is the issue of substance use. Few Kentucky residents in the 67 hardest hit counties remain untouched by a friend’s or loved one’s struggle with addiction. Our health care system is also dealing with the secondhand impacts. Kentucky is currently first in the nation for new hepatitis C cases and a 2016 Centers for Disease Control and Prevention report found that Kentucky is at risk of an HIV outbreak sparked by intravenous drug use.
Against this backdrop, the inclusion of substance use treatment under Medicaid is essential. Treatment services increased by 740 percent in the first 30 months of the expanded Medicaid program. This equates to more than 40,000 treatment services delivered each year. Access to professional rehabilitation for those struggling with a substance use disorder represents our best opportunity to end this destructive epidemic.
While it is too soon to see improvements in Kentucky’s health outcomes, Medicaid is truly making a difference in the measures that, according to research, will lead to better population health if we stick to it. Our goal must be to continue to improve and optimize Medicaid so we can realize the benefits of a healthier Kentucky.
Ben Chandler is president and CEO of the Foundation for a Healthy Kentucky, which works to address the unmet health needs of Kentuckians by developing and influencing policy, improving access to care, reducing health risks and disparities, and promoting health equity.