Health

The expansion of Medicaid came just in time for Vickie Young. For years, Young cleaned houses. The 63-year-old from Carlisle, Kentucky, bought her own health insurance, which kept  getting more expensive as she got older. She has a bunch of health conditions from cleaning all those years including two torn rotator cuffs and a deteriorating disc.

“And then when Obamacare was enacted, I went on and I qualified for Medicaid — [it was a] huge relief,” Young said.

But now she’s worried. On Wednesday a federal judge blocked Medicaid work requirements in Kentucky. It’s the second time Judge James E. Boasberg has struck down Kentucky’s proposal to change the state’s insurance program for low-income people — the first was in June 2018.

And Gov. Matt Bevin has said he would roll back the expansion of Medicaid altogether if he doesn’t get his work requirement policy. This has many Kentuckians with expanded Medicaid feeling nervous, including Young. The lawsuits from health advocacy groups trying to stop the work requirements actually make her mad, she said.

“I’m afraid these people that keep suing for this not to have this instated — all they’re going to do is cause Bevin to shut the whole thing down,” said Young. “So what are they going to win?”

Cabinet for Health and Family Services Secretary Adam Meier wrote in a statement that the court decision is just a setback in implementation of the work requirements. The Medicaid changes were set to partially go into effect April 1, with work or volunteer requirements not taking effect until July at the earliest. He also wrote that the state is considering next steps.

Those next steps will likely include appealing the decision to the U.S. Court of Appeals, according to Alexander Shekhdar, who runs the policy consulting firm Sycamore Creek Health Care Advisors in Washington, D.C. He said it’ll be politically tough for the governor to roll back expansion.

“Especially since he’s running for governor again, plus the fact that there’s a number of plans invested, beneficiaries are invested in it, and a lot of different other stakeholders are invested in it,” Shekhdar said. “So it’s not as not as easy to roll it back as to roll it out.”

Kentucky Democrats also have said that any attempt to pare back Medicaid expansion would immediately be challenged in court. Cara Stewart, chief of staff for the Kentucky House Democratic Caucus, told Modern Healthcare that Kentucky law wouldn’t allow Bevin to end expansion through an executive order.

Meanwhile, the groups that sued the federal government to keep the community engagment requirement from taking effect said they will sue again, according to Sam Brooke, deputy legal director at the Southern Poverty Law Center.

“We are hopeful that what will happen is that the federal government will rethink this and realize that this is counter to the Medicaid program and that it is not permissible with the Medicaid program to require work requirements,” Brooke said. “Of course, if they do [appeal], our colleagues at the National Health Law program and us at Southern Poverty Law Center and our colleagues in Kentucky and Arkansas would continue to fight this as long as it’s necessary.”

Mixed Feelings

Katherine Reed lives in Stearns, Kentucky, in McCreary County. She has multiple jobs as a school bus monitor, a substitute teacher and a health clinic receptionist. But none offer health insurance. In 2014 she gained Medicaid coverage after it was expanded — she’d been laid off as a cashier at a community college where she’d had health coverage.

“I would actually be lost without it,” Reed said. “I would not have any coverage.”

In the past few years Reed has had some health problems — one year, she was having chest pain and had a heart catheter operation. She’s also had a procedure to remove cataracts from her eyes. Another year she had back surgery. And she makes right on the edge of the income limit to qualify for Medicaid. Without it, she said she’s not sure how she would afford health insurance.

Reed is very worried about the prospect of Bevin pulling Medicaid expansion altogether — as he’s said he will do if his plan isn’t approved. The work requirements are easy for her to meet, and she figures that if someone can’t physically work, they can get a “medically frail” designation, which would exempt them from the work requirement.

“I would rather have to put in a few hours every week, to keep what I have, then to be tossed out there, to try to go without coverage, you know, or to pay out the ying-yang for something that’s not going to do me any good,” Reed said.

She said that for people who can work but don’t have skills that an employer might want, the state should help them with vocational training. That’s part of Bevin’s plan: job training counts toward work hours.

Vickie Young said she doesn’t think the work requirements go too far — but there are some issues she sees. Take, for instance, seasonal workers.

“I just think they’re too rigid, some people have transient jobs,” Young said. “What would a person who has a lawn care company do in the winter? They might be working 80 hours a week in the summer and not working in in the winter.”

In this scenario, there’d be no exemption for that worker, though an enrollee would have two months to catch up on hours.

With the upcoming gubernatorial election in November, Young said she plans on voting for a Democrat who will keep Medicaid as-is in Kentucky. .

Lisa Gillespie is WFPL's Health and Innovation Reporter.