Uninsured Rate Plummets

Within two years, the state’s uninsured rate had fallen to 6 percent of the population from 20 percent. More than 420,000 people had been insured through Medicaid expansion, dropping the number of uninsured in some low-income jobs -- at restaurants, construction sites, gas stations and discount stores, among others -- by between 35 percent and 52 percent, according to data from the Kentucky Center for Economic Policy, which studies impacts on the poor.

It had been easy for Bevin to run against Obamacare. Once in office, his promise meant killing the subsidized insurance much of the state depended on but didn’t know they had.

He turned to a consulting company then led by Seema Verma, now the head of the U.S. Centers for Medicare and Medicaid under Trump. Verma was also a health policy adviser to Vice President Mike Pence when he was governor of Indiana.

Premiums and Punishments

Instead of scrapping Kentucky’s expanded Medicaid, Bevin applied for the same kind of federal waiver won by other Republican governors, led by Pence. The waiver programs include Republican-looking add-ons -- premiums, punishments, so-called skin in the game for the poor -- that allowed the governors to expand Medicaid under Obamacare, while saying they were doing something else.

Bevin’s compromise may foreshadow where national Republicans end up on Obamacare. His still pending Medicaid waiver request puts the poor through more hoops to get insurance, adds complication and bureaucracy, could drive up administration expense and would inevitably cost some recipients coverage. It also keeps the expansion of Medicaid.

Depending on what happens in Congress, Bevin’s waiver has a good chance for approval from the agency Verma now heads. Bevin’s spokeswoman, Amanda Stamper, didn’t return three calls for comment on Bevin’s waiver decision.

Michael Rabkin, spokesman for Passport, the Medicaid managed-care company, said he didn’t know why Bevin changed his approach, “but I know a lot of people were talking to him, including my boss.

“There were a number of important people in the health-care field -- hospitals, doctors, Passport -- working to make sure that from the governor’s office on down, everybody knows what it means, how many people were affected and what would happen if it goes away,” he said.