What Will Happen to Kentucky’s Medicaid Expansion?

There have been a lot of back-and-forths around the country over the state option to expand Medicaid created by the Affordable Care Act of 2010. But until 2014, there was no serious prospect that a state which had already accepted the expansion would roll it back.

In the wake of that election, there was some talk that new GOP governors in Arizona, Arkansas, Illinois, Maryland and Massachusetts might reverse Medicaid expansions. But in the end they all opted for permissible benefit cutbacks and/or for schemes to secure “reforms” of the original and expanded Medicaid programs via a waiver.

Perhaps that is what will ultimately happen in Kentucky. But as Suzy Khimm explains today at TNR, newly elected governor Matt Bevin is the first Republican to flatly promise to repeal a Medicaid expansion that is already in place, along with repealing a successful state-created purchasing exchange for private insurance under Obamacare.

But on the Medicaid expansion, at least, Bevin has been all over the place since his initial pledge to just repeal Gov. Steve Beshear’s executive order accepting the expansion.

In February, Bevin asserted that he would undo Beshear’s executive action. “Absolutely. No question about it. I would reverse that immediately,” Bevin said. Since winning the Republican primary in May, however, Bevin has wavered. The Lexington Herald-Leader explains: “In July, Bevin said it was ‘an absolute lie’ that he ever said he would reverse the expansion on his first day in office.” But then he appeared to change his mind again: “In an August fund raising letter, he was back to calling for complete reversal.”

Bevin’s most recent position: Junk the current system and replace it with an alternative that’s likely to include premiums or co-pays. “I want these folks to have skin in the game,’’ Bevin said last week, echoing a popular Republican talking point. “People don’t value something they haven’t invested in.” The Republican insisted that he wouldn’t take away coverage from the 400,000 enrollees. But he also said in the interview that he “will not continue” to enroll Kentuckians at 138 percent of the federal poverty level, which is the threshold for Obamacare’s Medicaid program. (It amounts to about $16,200 for a single person.)

This sounds like Bevin’s laying the groundwork for a waiver request that would continuing expanded eligibility for Medicaid in exchange for conservative “reforms” of the whole program. In the meantime, though, he will almost certainly junk the state purchasing exchange, which, ironically, would drive Kentucky to a reliance on Heathcare.gov, the hated federal exchange.

Any way you slice it, Bevin’s going to be creating real-life consequences for real people, not just rhetorical attacks on an Obamacare straw man few understand. And other Republican governors on the fence on this issue will be watching.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.