Bevin betting mostly female Medicaid recipients won’t vote
Republican gubernatorial nominee Matt Bevin has said he opposes gambling on all levels but it looks like when it comes to providing healthcare to working poor families in Kentucky, he’s betting that they either don’t hear what he’s saying or are going to stay home on Election Day.
That’s a pretty good bet, if a Pew Research Center report from earlier this year is correct. It found that that the less financially secure a person is, the less likely he is to vote. Make that the less likely she is to vote, since the largest percentage of the financially insecure are women.
It’s those people who will most likely to be affected by Bevin’s call to eliminate health insurance for hundreds of thousands of working poor who became Medicaid eligible when the Affordable Care Act allowed states to provide coverage to folks who make up to 138 percent of the poverty level.
Gov. Steve Beshear decided to accept the federal government’s offer to expand Medicaid for a number of reasons.
First, the federal government agreed to pick up the full cost of the program for the first few years, starting in 2014. The state will have to pay 5 percent in 2017, gradually rising to the law’s limit of 10 percent in 2020.
Second, businesses that don’t provide health insurance to employees are required pay a $3,000 penalty to the government for every worker that receives a subsidy in order to pay health insurance premiums. But with the expanded Medicaid, businesses wouldn’t have to pay that penalty for workers that qualify. The state estimates that would save businesses $32 million to $48 million per year, the state estimates.
Third, hospitals need these people to be covered because they will see their federal funds for indigent care slashed by nearly $300 million, since the Affordable Care Act assumed that states would expand their Medicaid programs, making the larger sums of indigent care money unnecessary.
Kentucky’s Medicaid roll increased by some 430,000 people since the expansion took place in 2014 – the large majority due to that expansion.
Now, there are drawbacks. A study by Deloitte consulting found that the Medicaid expansion would pay for itself through 2020 because of the federal funds, increased jobs in the health-care industry and other factors. But in 2021, the study found, the state’s Medicaid expansion would go into the red.
Jack Conway, Bevin’s Democratic foe, has said that he would keep the expansion and that to do otherwise would be callous. But he hasn’t said how he would pay for the program in a second term other than to suggest that an improving economy and better jobs will eliminate the strain on the program and the number of people who need Medicaid.
Whatever, there’s not a need to rush to withdraw. As the federal government picking up the entire cost of expansion for now, and Kentucky could scale back the size of the expansion or do away with it if it finds it can’t pay as the state’s responsibility ratchets up.
Bevin won’t admit it, but his plan would force most of those 430,000 people off the federal insurance plan – leaving many of them without a way to pay medical bills.
After being asked repeatedly whether those people who earn up to 138 percent of the poverty level would still have health insurance, Bevin said, “They’re Kentuckians. They will continue to live in Kentucky if they choose to.”
While they are Kentuckians, the question is whether they will vote.
The Pew Center report used 10 criteria to determine people’s financial stability including one that dealt with whether they or anyone in their family received Medicaid, and another that dealt with whether they had trouble paying medical bills in the past year.
Of the least secure, 57 percent said they or a family member received Medicaid, and 64 percent said they had had trouble paying medical bills. Only 20 percent of that group were likely to vote in the 2014 election.
Of the next least secure group, 25 percent answered “yes” to the Medicaid question. Forty-three percent said they had trouble with medical bills, with 29 percent of them saying they were likely to vote.
By contrast, few in the top two groups received Medicaid or had trouble paying bills. Sixty-three percent of the most secure said they were likely to vote in the 2014 election and 51 percent of the second most financially secure group were likely to vote.
So, Bevin may be betting with the odds. But if 430,000 longshots come it, they could reshape politics in Kentucky.
By Joseph Gerth