EDITORIAL

The Advocate-Messenger

Kentucky has long ranked among the worst in the nation in many areas of health, but the state has seen improvements in recent years.

Better health means happier people and a more employable workforce. It also means less health care debt adding uncertainty to hospital’s bottom lines and families’ bank accounts.

In contrast to our poor rankings for tobacco use, opioid overdoses, cancer and poverty-related health problems, the Bluegrass State has obtained one of the best insured rates in the nation in recent years. Only 6 percent of the population was uninsured in 2017, according to the Kaiser Family Foundation.

Kentucky’s low uninsured rate has undoubtedly helped contribute to recent improvements in the state’s health, because being insured makes it more affordable to get health care of all kinds and easier to get many preventative health care services for very little money or even for free.

And our low uninsured rate has undoubtedly been a side effect of the state’s expanded Medicaid coverage, which began in 2014.

Since that time, “Kentucky’s uninsured rate for the nonelderly fell from 18.8% in 2013 to 6.8% in 2015, one of the largest reductions in the country,” according to KFF.

That should be great news for employers and prospective businesses looking to expand or locate in Kentucky. Our workforce is healthier and more ready to work now than at any other time in recent history.

But there could be cause for concern that the state may soon go backwards in this area, potentially losing the ground it’s gained since 2014. Kentucky is poised to implement a work requirement on top of the 2014 Medicaid expansion, which could reduce Medicaid enrollment by 95,000 people in the first five years, largely due to people failing to meet the new reporting requirements.

Supporters of the work requirements claim they would make more people work so they could continue receiving health insurance.

But at the same time, they seem to ignore the positive workforce and economic development benefits of having as many healthy, insured people as possible.

Ironically, Kentucky’s workforce could be depleted by rules written with the intent of making the workforce better.

A new study of Medicaid work requirements in Arkansas suggests that scenario is definitely a possibility, and certainly should be a concern for Kentucky if it continues to pursue the Medicaid work requirement.

The study published in the New England Journal of Medicine found that among 30- to 49-year-olds in Arkansas who were subject to the state’s new work requirements, the insured rate fell from 70.5% in 2016 to 63.7% in 2018. Other groups not subject to the work requirements, including residents in Kentucky, saw much smaller decreases or increases in insurance coverage over the same time period.

At the same time, the study found employment declined from 2017 to 2018, and self-reported disability increased.

“Employment declined from 42.4 percent to 38.9 percent among 30- to 49-year-old Arkansans,” according to The Commonwealth Fund, which supported the study. “Employment rates in the other comparison groups experienced a similar decline. There were no significant changes in hours worked in Arkansas either.”

In other words: “The first six months of Arkansas’ work requirements resulted in a significant loss of Medicaid coverage and a significant rise in uninsured rates, indicating that many people who lost Medicaid coverage did not obtain other health coverage. Researchers found no significant changes in employment associated with the work requirements.”

Kentucky doesn’t think the work requirement will have the same effect here as it did in Arkansas, Kristi Putnam, deputy secretary of the Kentucky Cabinet for Health and Family Services, told Melissa Patrick with Kentucky Health News.

Putnam told Patrick Kentucky has been working hard to communicate about the new requirements better than Arkansas, and has assembled many partners in order to try to make the new rules successful.

If the new requirements are allowed to take effect, we hope that’s the case and they don’t just harm Kentucky’s health and economy. But there’s not really great evidence to suggest that will happen.

Kentucky isn’t buying into proven strategy here; it’s trying to become one of the early adopters of an untested design — one that may already be causing problems for the earliest adopters.

Experimentation can be good — the Medicaid expansion itself was an experiment at the time — but it can also be disastrous. Kentucky should exercise an abundance of caution when it comes to messing with Medicaid. We have just begun climbing out of the health pit we were in; now is not the time to kick the legs out from under the ladder.