As a member of the Kentucky House of Representatives, a R.N., and a retired health care administrator, I wanted to carefully review the Kentucky HEALTH proposal, the Medicaid waiver, and fully understand the elements of the plan: the cost analysis, projection, and health benefits before commenting.
In a state of just 4.3 million citizens, we should all find it alarming that in the last decade, those enrolled in Kentucky’s Medicaid program has more than doubled from 600,000 Medicaid enrollees to just under 1.4 million Kentucky citizens!
We have some huge challenges before us.
Two weeks ago during the Appropriations and Revenue Interim Joint Committee Meeting, Secretary Brinkman and members of the Health and Family Services Cabinet presented an overview of the recently unveiled initiative to reshape Kentucky Medicaid, including the components of the proposed waiver known as Kentucky HEALTH, which will soon be submitted to the federal government. During the presentation, Committee members had the opportunity to engage in discussions on Medicaid enrollment, utilization, cost, future projections, and statistical information.
As I followed the criticisms and judgments since the Administration announced Kentucky HEALTH, I think this is one of those situations when a sensitive issue is touched, like health care for the disadvantaged, and everyone immediately retreats to a defensive position, often hearing only what they are expecting to hear. What fails to be reported and seems to get missed are many of the actuarial facts.
For instance, Kentucky’s Managed Care Organizations (MCOs) are paid more and their
average profits are greater than any other state in the nation. Governor Bevin’s Administration has already taken steps to correct this issue, renegotiating the contracts to ensure a more prudent use of taxpayers’ money. A savings of over $280 million is projected over the next six months. It will also ensure that more Medicaid dollars go to providing actual health care benefits to Medicaid recipients rather than MCO profits.
These are very complex matters, and after review, I believe the Administration has taken not just a dollars- and cents-approach, but a compassionate and common-sense approach, raising necessary questions that examine several problems with the current Medicaid program.
For example, are we leveraging state and federal dollars in the most cost-effective and responsible way? By providing government fully funded Medicaid to the able-bodied population, are we preserving sufficient resources to serve the most vulnerable Kentuckians: children, the aging, the blind, individuals with disabilities, and those most in need? Are we aligning our health policy and incentives with the desired outcomes — because truth be known, despite plenty of spending, we have not effectively moved the needle on improving health outcomes in Kentucky.
And how do we proactively assist Kentuckians to obtain health care coverage while at the same time ensure such assistance includes a path to independence and advances their potential, rather than binding our citizens in the cycle of dependency?
Kentucky HEALTH is not only fiscally responsible, but also reflects a keen understanding of how we should view our fellow citizens who are Medicaid-eligible. Over time, our well-meaning charity and compassion has robbed many able-bodied individuals of their capacity and productivity and driven them deeper into a life of dependence. It is actually “toxic charity” and insulting to individuals’ human dignity when we continue to think that Medicaid-eligible citizens are incapable of engaging in their own health care and taking actions to improve their well-being and health outcomes.
Kentucky HEALTH does not kick current recipients off of Medicaid, but it does require able-bodied individuals to engage in their community and themselves to earn additional benefits over the standard benefit package through activities such as community service, working on their GED, or job training.
Many of the proposed Kentucky HEALTH initiatives and incentives that encourage individual health care responsibility and improved well-being are the very same ones that were incorporated into the private and public employee insurance and health care plans over a decade ago. Why would we NOT want the same benefits, with proven outcomes, for our Medicaid-eligible citizens?
The proposed waiver and changes incorporated in the Kentucky HEALTH plan will preserve Kentucky taxpayers’ dollars and ensure health care for our most vulnerable citizens and the uninsured–but it doesn’t stop there. Kentucky HEALTH provides for our able-bodied Medicaid recipients to also become informed and responsible health care consumers and provides them an opportunity to improve their lives and rise out of the welfare trap.
The time has come for a principled and fiscally responsible approach to improving the lives of all our citizens—an approach that incorporates dollar and cents as well as compassion and common sense. Governor Bevin’s Kentucky HEALTH plan does exactly that.
Addia Kathryn Wuchner is an R.N. and state Representative and vice chair of the House Health and Welfare Committee. She is originally from Louisville, resides in Boone County, and serves the people of the 66th House District. She former Vice President of Strategic Planning for St. Luke Hospital and The Health Alliance, and Founder/Director of Project Wings of Mercy – Hope and Humanitarian Aid Medical Missions.