When you live in Kentucky, you have several options for health care coverage. You can enroll through your employer, buy a policy from a private company, or get Medicaid or Medicare.
The Affordable Care Act (ACA) was enacted in 2010, aimed at expanding access to affordable health insurance and reducing the uninsured rate. However, if the Supreme Court strikes down the law, it could be devastating for Kentuckians and the entire state.
The ACA’s Impact on Kentucky
Kentucky’s ACA health care programs not only help hundreds of thousands of Kentuckians get health coverage when they need it, but they also provide a powerful stimulus for our economy. Every year, subsidized marketplace coverage and Medicaid expansion boost our local economies by investing more than $3 billion in federal funds into our state.
But the ACA’s impact on the state is at risk. If the House Republican ACA repeal bill becomes law and Medicaid expansion and subsidies on the exchange end, Kentuckians could lose health insurance altogether, causing many to fall into poverty.
Kentucky was among the first states to implement both ACA coverage expansions and has seen substantial success. This was achieved through a combination of strong leadership and collaboration, a high-functioning integrated eligibility system, a broad outreach and marketing effort, and a strong network of enrollment assistance. These factors have allowed Kentucky to achieve significant coverage gains and close racial and ethnic disparities.
Pre-Existing Conditions
Before the Affordable Care Act (ACA), many Americans were denied health insurance coverage or faced higher premiums because of a pre-existing condition. This included a wide range of medical conditions, such as cancer, heart disease, and asthma.
In Kentucky, before the ACA, nearly 33 percent of non-elderly Kentuckians had pre-existing conditions that would have kept them from getting insurance. This is more than the national average of about 29.4 million women with a pre-existing condition before the ACA, but still lower than the other states that ranked higher in the Kaiser Family Foundation report:
After the ACA passed, insurers cannot deny you coverage or charge you more for your plan because of any condition that you have. This protection applies to both the Marketplace and Medicaid.
Medicaid Expansion
Kentucky opted to expand Medicaid in 2013, one of the first states to do so, and has led the nation in the decline of uninsurance rates among adults. It was an ambitious and successful effort that involved a robust implementation of the Affordable Care Act, including Medicaid expansion, a state-based marketplace (kynect), and an extensive outreach and enrollment campaign.
In 2018, Governor Matt Bevin sought and was awarded a Section 1115 waiver to modify the Medicaid program in Kentucky called “HEALTH.” The waiver included premiums for some members, deductible and incentive accounts similar to health savings accounts, and a first-of-its-kind work requirement for able-bodied adults.
Bevin’s plan would have had many negative impacts on enrollees. They would have had to pay higher premiums for coverage they previously received at no cost, would have had to undergo a disenrollment and lock-out period if they did not renew their coverage, and would have faced many other hoops. Moreover, they would have had to report changes in their circumstances.
Tax Credits
The Affordable Care Act has provided many tax credits to help lower the cost of health insurance for Kentuckians. These tax credits are made available to individuals and families based on their income level and can be used to purchase marketplace coverage or qualified health plans.
In just four years, the ACA’s premium subsidies, protections for pre-existing conditions and Medicaid expansion helped reduce Kentucky’s uninsured rate to 5.1% of noninstitutionalized residents. This historic decline has helped to close racial and ethnic disparities in coverage rates across Kentucky.
In addition, the ACA created a Small Business Health Options Program (SHOP) that allows for-profit businesses with 50 or fewer full-time equivalent employees to offer health insurance through the marketplace. Those companies can also receive additional subsidies to lower their premium costs.
