Kentucky Gov. Matt Bevin's efforts to reshape the state's approach to the Affordable Care Act have led to a political battle of governors unprecedented in recent state history.
On Thursday, former Gov. Steve Beshear, a Democrat, launched a political nonprofit organization to advocate for key policies implemented by his administration, which ended in December. Those policies included an expansion of Medicaid and the creation of a state health insurance exchange, called Kynect.
Both policies are being threatened by Bevin's administration, which is seeking to add new stipulations to Medicaid enrollment and to dismantle Kynect, instead sending Kentuckians to the federal health care exchange.
Beshear's new group is called Save Kentucky Healthcare, a 501c(4) organization.
“Save Kentucky Healthcare is committed to continuing Kentucky’s dramatic success in expanding health insurance under the Affordable Care Act. Now, why? Because it’s working,” Beshear said during a news conference Thursday in Louisville.
The 61st governor's hop back into the political fray was quickly met with a response from the 62nd. During a news conference Thursday afternoon in Frankfort, Bevin said his job is to address problems he sees in how the Affordable Care Act was implemented in the state.
"This decision arbitrarily, unilaterally to expand Medicaid, bypassing the legislature to disregard completely how to pay for it and leaving that for the next governor to clean up -- I am that next governor, and I'm attempting to clean it up," said Bevin, who was elected in November by a 9-percentage point margin.
Beshear implemented the ACA in Kentucky under executive order. Since 2013, more than 500,000 Kentuckians have used Kynect to enroll in a qualified health plan or Medicaid.
A recent Gallup-Healthways poll reports Kentucky’s uninsured rate is down to 7.5 percent. It is among the greatest drops in the rate of uninsured among all states.
During last year's gubernatorial campaign, Bevin said the state's adoption of Affordable Care Act provisions was too costly. Since taking office, he's said the Medicaid expansion alone would lead to a $128 million budget shortfall in the 2016 fiscal year. That cost, combined with the state's flailing pension systems, led Bevin to propose a deep budget cuts to most state agencies.
Beshear said his organization would conduct an online campaign to educate voters about the impact of changes to Kynect and Medicaid expansion; drive awareness of the benefits of Kentucky's current approach to making health insurance accessible; and engage with advocates, health organizations and elected leaders.
He also said a petition organized through the campaign to remind Bevin that Kentuckians want to keep their health care already had more than 1,000 signatures as of early Thursday afternoon.
Beshear said Kentuckians deserve to keep their access to health care regardless of which political party is in power.
“Our ultimate goal is to preserve access to affordable health care for every Kentuckian no matter what the delivery model may look like," he said.
Bevin said he would meet with Health and Human Services Secretary Sylvia Burwell in Washington in the coming weeks to address the affordability of health care in Kentucky. In December, Bevin notified HHS of his intention to "wind down and cease operation" of Kynect.
In response to Bevin's notification, the federal government outlined a list of transition activities the state must carry out to start the process of dismantling the exchange.
The activities, listed in a letter to Bevin, demonstrate the unique challenges the state faces by ceasing to operate its own exchange.
The letter points out that Kentucky has successfully integrated eligibility and enrollment within the Kynect system for Medicaid/CHIP and the health care marketplace.
The state also has $57.5 million in unused federal funds that were part of $289.3 million it received in grants to establish Kynect. The leftover money cannot be used for ongoing operations of Kynect, nor can it be used for information technology costs associated with transition to the federal marketplace.
There are five steps Bevin and his administration must take immediately if Kentucky plans to transition for 2017, according to the letter:
1. Identify a point of contact in the state who will be responsible for transition activities. The state will also have to establish a project coordination team responsible for coordinating activities among the different agencies and with Kynect.
2. Provide a detailed plan for how Kentucky will continue to meet its obligations as a state-based marketplace through 2016.
3. Facilitate discussions between the Center for Medicare and Medicaid Services and the issuers participating in Kynect.
4. Begin the process required to enter into necessary contracts with a vendor to modify the Kynect system to decouple the marketplace from Medicaid/CHIP and build new system functionality.
5. Provide a detailed plan for how Kentucky will meet its ongoing statutory and regulatory requirements for 2014, 2015 and 2016 marketplace consumers.
Bevin spokeswoman Jessica Ditto said state officials would return any unused money.
Beshear, who could not seek re-election because of term limits, said there is a laundry list of detailed changes for Kentucky to move from a state-based exchange to the federal marketplace.
"One of the things that Save Kentucky Healthcare is going to do is to educate the public about what is going to have to happen and what it's going to cost them to move from a state-based exchange that works, that is helping people right now and that is not costing us anything, to the federal exchange," Beshear said.
When it launched in fall 2013, Kynect was hailed as a model for state-run health care exchanges.
State Sen. Tom Buford, a Nicholasville Republican, said the Bevin administration should give back whatever funds won't be used for Kynect. But when it comes to Medicaid expansion, he said he doesn't see the state pulling out.
"I think that would be a very difficult thing to do once you have established these individuals in Medicaid. You cannot pull the rug out from under them," he said.
Buford said the state would have to eat the cost.
"It will consume all of our generated new revenues probably for the next couple of years, which means we will make cuts to universities, education and all other programs to keep the Medicaid program sufficiently funded," he said.
State Rep. Joni Jenkins, a Louisville Democrat, said dismantling Kynect would be illogical. She said the state has the ability to provide affordable health care to Kentuckians, and the Bevin administration is threatening to thrown it away.
"I am just so disappointed that what seemed to be political rhetoric during the campaign is becoming policy, and I think very bad policy," she said.
Jenkins said the state would have to rebuild its platform in 2016 for people to sign up for Medicaid and other benefits for which they may be eligible.
"We are in a wait-and-see, because we have not seen the proposal from the Cabinet [for Health and Family Services] or the governor, so we don't know exactly what this transformation of expanded Medicaid will look like," she said.