Republican legislators question cabinet's figures on managed-care payments and cost projections for Medicaid expansion

Audrey Haynes (cn|2 image)

"When Audrey Haynes sat down before the legislature’s Medicaid Oversight and Advisory Committee Wednesday, she expected the data she brought would persuade lawmakers that Kentucky’s expansion of Medicaid has been good for the state," Ronnie Ellis reports for CNHI News Service. "The secretary of the Cabinet for Health and Family Services, which administers the Medicaid program also may have expected her statistics to ease unhappiness with the state’s move to managed care for most Medicaid services."

"It didn’t happen," Ellis writes. "At least she didn’t persuade Republican members who openly questioned the validity of the cabinet’s data, a couple stopping just short of saying the cabinet is making up the numbers" about payments to providers by managed-care organizations, which it says are 99 percent on time. “The numbers do not appear to represent the reality on the ground,” Rep. Richard Benvenuti, R-Lexington, said after the meeting.

Sen. Ralph Alvarado

“I think those are false,” Sen. Ralph Alvarado, R-Winchester, said after the meeting. “I don’t know if they’re lying, but somebody is providing bad information.”

During the meeting, Alvarado read "segments of letters from providers who have not received full reimbursements from managed care organizations," reports Kevin Wheatley of cable channel cn|2's "Pure Politics."

"Haynes referenced a report from CHFS which showed that over 90 percent of Medicaid claims are being paid in a timely manner," reports the blog of the Kentucky Chamber of Commerce. "Sen. Alvarado replied that this statistic does not match what he is hearing from his constituents and medical providers." Haynes addressed the managed-care issue in her PowerPoint presentation, downloadable here.

Rep. David Watkins, D-Henderson, a retired physician and co-chair of the committee, "urged the panel to find ways to improve managed care."

Watkins said the managed-care organizations, which are insurance companies or their subsidiaries, should come before the committee to answer questions. “I’m not totally satisfied that they’re doing quite as good a job as your report here would portray,” he told Haynes. “I think they need to be more accountable. I think they need to be more responsive to the providers who actually are doing work in the field.”

The MCOs will appear before the joint House-Senate committee Aug. 19, Brad Bowman reports for The State Journal in Frankfort. For cn|2's three-minute clip of the discussion between Haynes and Alvarado, via YouTube, click here.

The Republican lawmakers also voiced skepticism, but offered no contrary evidence, about the cost of expanding Medicaid to households with incomes up to 138 percent of the federal poverty level, from the previous limit of 69 percent. Under the Patient Protection and Affordable Care Act, the federal government is paying the entire cost of the expansion until next year, when the state will begin paying a small part, rising to the law's cap of 10 percent in 2020.

Haynes noted projections for Democratic Gov. Steve Beshear's administration that the expansion would add $30.1 billion to the state's economy through 2021, and would pay for itself until then, even after the state starts picking up part of the cost. The numbers were not new; they were part of a study by Deloitte Consulting and the University of Louisville that Beshear released in February.

Republicans focused on the prediction that the expansion would cost the state a net $45 million in 2021. "I know that seems like a way long ways off and some of you may no longer even be in the position to deal with it, but some of us probably will and the taxpayers will," said Alvarado, a physician.

Haynes "stated that she believed with the financial boost to the economy through jobs, the costs will be offset," the blog of the Kentucky Chamber of Commerce reports.

“Now that we’re seeing the lowest unemployment that we’ve seen in our state in quite a number of years, I’m sure each of you are amazed at how that we’ve had all 120 counties in our state where the unemployment rate has gone down,” Haynes said. “As this state continues to generate revenue and hopefully, as is planned, this is a bridge program for people who basically are hard-working people, but their employer does not provide insurance or they have children and therefore that qualifies them from an income basis for Medicaid.”

Reform law's backers say it boosts economy by freeing 'job lock;' foes cite estimate that it will make some drop out of job market

As the Patient Protection and Affordable Care Act's second enrollment period gets underway, supporters of the law say it boosts the economy by creating an affordable, accessible insurance market that's not dependent on employer-based insurance.

Travis Kalanick, co-founder of Uber, said the law has been "huge" for his personal-transportation business. Uber's drivers are independent contractors, so the company does not provide them with health insurance. But because the ACA creates a functioning individual market for health insurance, making it easier and more affordable for Uber drivers and others to buy coverage on their own, Americans don't have to stay in a job just to keep their health insurance.

"The democratization of those types of benefits allow people to have more flexible ways to make a living,” Kalanick said during dinner for reporters, according to Buzzfeed. “They don’t have to be working for The Man.”

This is why Uber loves Obamacare, reports Jason Millman of The Washington Post. For a company like Uber, it's about liberalizing the workforce so that people are able to take jobs they do like that don't provide health care, he writes.

Numerous sources cite the ability of individuals to obtain affordable coverage outside of the workplace as a boon to the labor market. A Congressional Budget Office analysis earlier this year said giving families more options for obtaining affordable health insurance outside the workplace, the PPACA removes a barrier to job mobility and boosts the economy.

Before the PPACA, many Americans’ only source of secure health-insurance coverage was through their jobs because without work-based plans, people often found coverage to be too expensive or impossible to obtain due to pre-existing conditions. This created a health-insurance obstacle to labor mobility, which is sometimes called "job lock", writes the Jason Furman in an online post from the White House Council of Economic Advisers.

Job lock can prevent individuals who want to look for a better job, change careers or start a new business from doing so for fear of not having health coverage, the CBO said. Now, because of both the PPACA’s patient protection measures and ban on discrimination against people with pre-existing conditions, Americans have reliable access to health insurance without having to count on employers to provide it, says the report. CBO also said many Americans will be able to start small businesses or take new positions where they can be more productive because they don't have to worry about health insurance.

Opponents of the law argue that it shrinks the labor market. For example, in a Forbes article, Avik Roy writes that the law hampers job growth by imposing one of the largest tax hikes in U.S. history, increasing the cost of employing workers and establishing exchange subsidies that encourage workers to drop out of the job market. They cite a CBO estimated that by 2024, 2.5 million full-time-equivalent workers will drop out of the job market. Jay Carney, then White House press secretary, celebrated the findings, arguing that they mean that Americans would no longer be “trapped in a job,” Roy writes.

Claims that health-reform law is putting Kentuckians out of work don't hold up to scrutiny, economic experts say

"Key Republicans running for election Nov. 4 say the federal Affordable Care Act is putting Kentuckians out of work, but employment data and interviews with Kentucky-based economists suggest otherwise," John Cheves reports for the Lexington Herald-Leader.

The objects of Cheves's scrutiny are a television commercial for U.S. Rep. Andy Barr, R-Lexington, saying Democratic challenger Elisabeth Jensen "supports Obamacare, which has decimated Kentucky jobs," and an opinion piece, by Sen. Mitch McConnell saying "There are so many stories about businesses holding back from expanding or hiring — or even cutting back on their workforces — it's hard to even count."

McConnell's anecdotal assertion proves nothing, and Barr's appears to be false. Cheves notes that Kentucky has gained 3,600 health-care jobs during the last year and quotes experts: Manoj Shanker, an economist at the state Office of Employment and Training, who said the law "is expected to be a net gain for the economy . . . and not just for doctors and nurses. It will mean the creation of jobs in other areas, including clerical staff for processing claims, more receptionists, more pharmacy technicians and clerks, more janitors, orderlies and ambulance drivers."

Glen Mays, a University of Kentucky public-health professor who studies health economics, told Cheves, "I think the law is definitely going to stimulate the health-care segment of our local economies, especially where we've seen substantial drops in the numbers of people who are uninsured. People who were forgoing medical care because they did not have insurance now can access it."

Grimes and McConnell lay out differences on health reform

By Al Cross and Megan Ingros
Kentucky Health News

U.S. Sen. Mitch McConnell kept attacking federal health-care reform and challenger Alison Lundergan Grimes gave her strongest defense of it yet as the candidates held the closest thing to a debate Wednesday, Aug. 20, at Kentucky Farm Bureau headquarters in Louisville.

Grimes was the most detailed she has been in a public discussion about health-care reform. Grimes indicated that she supports Kynect, the state health-insurance exchange, created by Gov. Steve Beshear and funded by Obamacare, where people sign up for Medicaid or buy insurance.

“For the first time ever, because of our governor, 500,000 Kentuckians are able to go to the doctor, their kids get checkups before school, and many of them are farm families in rural Kentucky,” she said. “The law isn’t perfect but we have to work to fix it. . . . We have to work to streamline the Affordable Care Act, to make sure there aren’t over-burdensome regulations on our businesses, especially our small businesses.”

Grimes endorsed President Obama’s delay in the law’s employer mandate and suggested that he should also live up to his promise that “If you like your doctor, you can keep it.”

She actually appeared to be referring to keeping old insurance policies, because her next words were, “We should be working to extend that grandfathering clause so we live up to that promise that Washington politicians made to Kentuckians. . . . It requires a senator, though, who doesn’t want to repeal root and branch the access to health care that Kentuckians just got for the first time.”

McConnell answered, “She won’t use the words, but she supports Obamacare, he single worst piece of legislation that’s been passed in the last half-century.”  He said Obamacare is going to cost jobs and it “ought to be pulled out root and branch and we ought to start over.”

McConnell said what should have been done is “truly national competition among health-insurance companies to keep prices down and quality up,” as well as “a national medical malpractice standard to bring some sanity to the litigation lottery that’s confronting every health-care provider in America; and thirdly, we need to allow small businesses to form groups for the purpose of more purchasing power on the open market.”

Citing a study by the Congressional Budget Office, McConnell said the law will only cover 10 million of the 40 million people who were uninsured, and will “cost 2.5 million jobs.” The study says the predicted reduction, through 2024, will come “almost entirely because workers will choose to provide less labor,” not because jobs will be eliminated.

McConnell said Kentucky will not be able to afford its expansion of the Medicaid program, which covers about three-fourths of the newly insured. “She applauds it,” he said. “It’s fine for the governor because the first three years the federal government will pick up 100 percent of the tab, but after that, the state’s going to be in serious financial problems.”

Beshear has cited studies showing that the Medicaid expansion will pay for itself by expanding the health-care industry and creating jobs, but Republicans say they are skeptical of that.

A video of the debate is available on the Farm Bureau website, www.kyfb.com, until Sept 20. The specific site is http://new.livestream.com/accounts/7542430/events/3309694.

'Hard times' help 13 more schools in Paducah area join about 20 in federal program that gives free meals to all students

Thirteen more schools in the Paducah area will offer free breakfasts and lunches to all students under a provision of the federal school-lunch program, joining about 20 others in the region, reports Genevieve Postelthwait of The Paducah Sun.

"Schools that are new to the program include Hendron-Lone Oak, Calvert City, Lowes, Wingo, Graves Central and North Livingston elementary schools; Fulton County elementary and middle school; South Marshall, Livingston and Ballard County middle schools, and Ballard Memorial, Fulton County and Graves County's Gateway Academy high schools," Postlethwait writes.

"They will join a group of about 20 other area schools that have qualified for and opted into the Community Eligibility Provision (CEP), a component of the Healthy, Hunger-Free Kids Act of 2010 that allows high-poverty schools to provide two square meals a day for all students at no cost to parents. . . . CEP schools must have 40 percent or more of their students "direct certified" as at-risk for food insecurity through state data. Direct-certified students include those whose households participate in the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families Cash Assistance (TANF) or Medicaid, as well as those who are in foster care, a Head Start program, or are homeless or migrant children."

In Ballard County, where all schools now have free meals, Food Service Director Amber Hayes told Postlethwait that CEP has made a difference has been critical for parents on "the bubble" because of layoffs at a paper mill, the U.S. Enrichment Corp. plant and the Honeywell Inc. plant in Metropolis, Ill., across the Ohio River from Paducah. "Good-paying jobs are hard to find," she said. "Some parents are making too much to qualify for most assistance programs, but it's still not enough." (Read more; subscription required)

Health care jobs are expected to expand as we age; newspaper in Bowling Green looks at its region

Jobs in health care are not only available for those without bachelor's degrees, such jobs are likely to become more prevalent, according to data collected in the Barren River Area Development District, Monica Spees reports for The Daily News in Bowling Green.

Ron Crouch, director of research and statistics for the Kentucky Education and Workforce Development Cabinet, compiled the data after the release of a national report of health care and health care education by the Brookings Institution.

“The demand for health care is going up,” Crouch told Spees. He said positions such as dentists, pharmacists, anesthesiologists, surgeons and other occupations will see in increase by 2020; and many of these jobs don't require more than an associate degree.

Crouch said there were 477 medical assistants in the region in 2010, with a projection of 573 by 2020. Medical assistants were paid $12.54 per hour in 2013. He also cited 634 licensed practical and licensed vocational nurses in the region in 2010, with a projection of 776 by 2020. These positions were paid $16.47 per hour in 2013. Health billing and maintenance jobs, which don't require a degree, are also available in the region.

Jobs that require a lower level of education are in high demand because they help people provide for themselves and their families without incurring college debt, Crouch told Spees. He also said that while 83.2 percent of health care positions in the region are filled by women, these jobs are suitable for both men and women.

As the population ages, the demands for health care will increase, Crouch said. In 1980, there were approximately 58,600 people older than 50 in the region. In 2010, there were almost 93,000.