More on Kentucky

Via Tbogg:


The 1115 waiver is how Montana, Alaska, Iowa, Arkansas and half a dozen other states have expanded Medicaid.  If straight up Medicaid expansion is replaced with a 1115 waiver Medicaid expansion in Kentucky, then most of the 420,000 people who are on expanded Medicaid in Kentucky will still have coverage although it has been worse coverage.

The 1115 waivers that have been approved have set some strict limits:

  • No more than 2% of income can be spent on premiums and only if people make more than 100% of the Federal Poverty Line
  • Cost sharing can be maxed out at 5% of income
  • Redetermination of eligibility can happen annually instead of every six months
  • Health Savings Accounts are approved with state seed money
  • Medicaid is not tied to job or educational efforts.

I don’t think Kentucky would go Arkansas model of paying for private insurance.  Arkansas is seeing that this route is extremely expensive.  So far it has not mattered for Arkansas as the Federal government has been paying 100% of the cost to expand Medicaid without calling it Medicaid Expansion or Obamacare.  That changes on 1/1/17 as the states will have to start kicking money in.  The Arkansas model will cost the state an incremental $15 to $20 million dollars per year over straight up Medicaid expansion.

If we assume the Center for Medicare and Medicaid Services follows their precedent, a probable Kentucky 1115 waiver will impose some premiums or mandatory HSA contributions, some non-ambulatory transportation services will be cut and cost sharing for emergency room visits will increase.  The premiums will push some people out of the program.  Everyone else will have another hoop to jump through but they’ll still have coverage.

I thought this was a 10% probability last night, but with new information I’m bumping this up to a 60% probable outcome.

38 replies
  1. 1
    Baud says:

    Can you imagine if a Dem backtracked on his central policy position like this?

  2. 2
    Baud says:

    I suppose it’s cold comfort that Kentuckians only hate Obama and may not hate their fellow citizens.

  3. 3
    Punchy says:

    I’ve grown tired of trying to figure out the appeal of radical Repubs. Apparently their policies are deemed superior to what the Dems are offering. I’m at a loss, but done trying to explain it.

  4. 4
    azlib says:

    So much for being fiscal conservatives.

  5. 5
    Kropadope says:

    @azlib: It’s called personal responsibility. Kentucky will pay more to make sure that they’re poor people can’t have nice things, like job security or healthcare.

  6. 6
    OzarkHillbilly says:


    I’m at a loss, but done trying to explain it.

    It’s really pretty simple: IGMFY.

  7. 7
  8. 8
    BGinCHI says:

    Spelled the title wrong. Here you go:

    Moron Kentucky.

  9. 9
    BGinCHI says:

    Richard, 2 questions:

    1. How much did it cost KY to get Kynect up and running and how much will it cost (roughly) to dismantle?

    2. How many people could that money save or raise their quality of life?

  10. 10
    Richard mayhew says:

    @BGinCHI: dismantling is cheap, pro ably a few million go transition their data backend to I have no idea what the startup costs were.

  11. 11
    Keith says:

    Looks like on this Mac the TBogg Tweet and all related posting is populating every other post on the Front Page.

    I know the subject is important (it is) – but surely this is an error?

  12. 12
    mainmata says:

    Haters gotta hate even if they have to pay a lot to enjoy their hatred.

  13. 13
    Gin & Tonic says:

    @Keith: Every new post gets added at the top of every previous post. It’s the Department of Redundancy Department making sure you read all the pearls of wisdom every time.

  14. 14
    Baud says:


    Freedom (to hate Democrats) isn’t free.

  15. 15

    @Baud: Will voters notice that they’re basically getting a harder to use version of Obamacare? One the law totally allows?

  16. 16
    BGinCHI says:

    If someone sees a great takedown of what is going to happen to the KY economy under Big Austerity, please post it here.

    I’m guessing that in a state that gets heavy federal subsidies (Appalachia and W. KY) and has an economy heavy in coal and auto manufacturing by mostly foreign companies at low wages, the lack of investment in the state, cuts to education and services, and more regressive tax policy is going to mean a shit economic future.

    Who thinks this is a recipe for KY to get smarter, more technological, raise the quality of life?

    Welcome to Kansatucky.

  17. 17
    Baud says:

    @Iowa Old Lady:

    I don’t know what it’s like in Kentucky. The federal website will be different from the state website. The Medicaid piece will take a few months at least to be implemented. But I’m confident that no one will blame Bevin for any problems they encounter.

  18. 18
    C.V. Danes says:

    As goes Kansas, so goes Kentucky.

    There’s a reason why I left KY 25 years ago and never looked back.

  19. 19

    @Baud: Iowa has a tweaked version of Medicaid. I was glad the state accepted the funding, but from what I can tell, it’s harder to use. There’s more bureaucracy and it costs. So it’s basically a CYA move by the Republican governor. He gets to say it’s not really Obamacare.

  20. 20
    Baud says:

    @Iowa Old Lady:

    We’ll see. They made their bed.

  21. 21
    Gimlet says:

    They will grumble about the shortcomings and tell themselves it could be worse. It could be Obamacare.

  22. 22
    OzarkHillbilly says:

    So… This Republican Governor elect is now promising to turn the whole thing over to the Feds. Whatever happened to believing in local governance as a cornerstone of conservative philosophy?

  23. 23
    BillinGlendaleCA says:

    @OzarkHillbilly: Less important than blaming the darker hued Democrat?

  24. 24
    OzarkHillbilly says:

    @BillinGlendaleCA: DOH!!! But of course, how silly of me.

  25. 25
    Derelict says:

    What’s the appeal?

    “Elect me and I pledge that I will not make your life better. Instead, I will make someone else’s life worse–and I’ll let you watch!”

  26. 26
    Sherparick says:

    @OzarkHillbilly: The Democrats are the party of Blacks, hippies, cultural libertines, cultural snobs, “illegal immigrant” (e.g. Hispanics), and Godless environmental commies who hate coal to 70% of Kentucky’s white population that votes. I expect a lot Kentucky poor and working class whites don’t vote. Tribal affinity, defending the vestige of white privilege, and general feeling that taxes are used for “those people; ” resentment and anger at stagnating incomes and standard of living, and society that really does seem to becoming worse for them and their kind. http://www.lawyersgunsmoneyblo.....atastrophe

    I have to give Bernie Sanders credit for a least making a outreach argument to rural and poor whites. But he quickly gets beaten up for it from the Black community and liberal elites for being soft on the racism of these people. However, the re-segregation of politics in South and South in spirit states, from North Carolina through to Arizona and from Georgia to Idaho, into a Party of White People (Republicans) and the Party of the Others (Blacks, Hispanics, Hippies, and Abolitionists) has not worked out well for Blacks or poor and working class whites in these states.

  27. 27
    Sherparick says:

    Why do poor and white working class voters either not vote, or if they do, vote Republican. Again, with the decline of good, secure jobs, private sector unions and the capture of the Evangelical church by the Conservative Movement, the institutions that could once organize them to vote to use Government to better their conditions and defend themselves from the predatory instincts of the rich have disappeared. As Pete Seeger once sang, you need a union to help you know which side you are on, to organize, and agitate. Now you have church telling them that the rich are rich because they have God’s grace and the afflictions visited on them are the result of God’s punishment for the libertine ways of women and gays and that they need to prepare themselves for the rapture.

  28. 28
    MomSense says:

    I feel your pain, Kentucky. It is unconscionable to let poor people go without access to health care out of some desire to punish them for not earning enough. It is especially disgusting to do this knowing full well that they are unable to earn enough in the low paying job economies these same Republicans defend and promote.

    Our governor LePage infamously told a story during his first campaign about how he had this great employee at Marden’s but he couldn’t give her a raise above $10/hour, even though she deserved more, because she would lose her MaineCare. Here is a governor who opposes any minimum wage let alone an increase in the minimum wage. He also reduced the numbers of people eligible to receive MaineCare benefits. So he admitted to gaming the system at Marden’s by keeping employee wages low so the taxpayers would pick up the tab for their health benefits (food assistance too!) and then he turned around and screwed his former employees once elected by kicking them off MaineCare and opposing attempts to pay them enough to be able to purchase health insurance. Oh and did I mention he also gave a big tax cut to the wealthy in our state? That is just the icing on the Republican fuck-you economy cake.

  29. 29
    What Have the Romans Ever Done for Us? says:

    @OzarkHillbilly: Ummm. Isn’t it obvious that screwing people of limited means (and its corollary of coddling the rich) is the lodestone of conservative ideology at this point? Everything that conflicts with that, including “local control” is secondary. There’s an opportunity to screw the poor here and it must be seized.

  30. 30
    jake the antisoshul soshulist says:

    I worked with the Lt. Governor-elect. Despite the fact she is African-American, she has pretty bog-standard Tea Party views.
    She is from Detroit originally, and one day she had a rant about how 60% of the people in Detroit were functionally illiterate. And
    remarked on her frustration that her mother continued to vote Democratic, despite what the Democrats had done to Detroit.
    And said something about that she could have stayed in Detroit and sold drugs.
    Which is pretty standard view from Tea Partyish conservatives.
    That the problems in urban centers are due to Democratic misgovernance rather than economic and demographic changes which
    are beyond the control of government.
    Recently the local (right-wing) paper had an editorial applauding new manufacturing locally and touted the $10.80/hr beginning rate as good wages. Which, sadly, is relatively good compared to the more common $8 to $9 starting pay.

  31. 31

    @MomSense: Marden’s is like a huge junkyard. I thought Mainers had better sense than vote for the CEO of Marden’s.

  32. 32
    Matt McIrvin says:

    Interesting that he seems to know he can’t just yank the Medicaid expansion entirely. That’s something.

    Shutting down the state exchange and going to the federal one may actually be a good thing in the long run, from the perspective of someone wanting to see real national health care happen. Is there any good reason for the state exchanges anyway, aside from a symbolic embrace of American-style federalism?

  33. 33

    @Matt McIrvin: Best reason for a state based exchange is that they can facilitate a significant and complex Wyden Waiver far easier than . It makes plenty of sense for New York and California to go off on their own, but for smaller states (Vermont for instance) or states that are not interested in complex Wyden Waivers, state based markets are either too expensive/complex or just too much firepower for a fairly simple set of tasks.

  34. 34
    MomSense says:

    @schrodinger’s cat:

    Well we had a split vote in both elections on the Dem side with Cutler, the Independent candidate.

  35. 35
    Brachiator says:


    I expect a lot Kentucky poor and working class whites don’t vote. Tribal affinity, defending the vestige of white privilege, and general feeling that taxes are used for “those people; ”

    Voter turnout was low, 30 percent, but I don’t know how that breaks down in terms of income groups. And Kentucky is only 8 percent African American and 3 percent Hispanic (2014 numbers), so that is not a lot of “those people” to fuel any resentment.

    I don’t even understand the hatred that the governor has for Obamacare, or why voters would be so happy to inconvenience themselves by making it even relatively more difficult to get health insurance for themselves and their families.

  36. 36


    I’m starting to agree with what Sherpatrick said — these people think they have a religious duty to suffer and any government program that helps alleviate that suffering is sinful. That’s why they’re completely impervious to arguments about how food stamps or health insurance would make their lives better — if God thought they deserved that, He would provide it, not the government. To accept something God did not provide is a sin.

  37. 37
    Brachiator says:

    @Mnemosyne (iPhone):

    I’m starting to agree with what Sherpatrick said — these people think they have a religious duty to suffer and any government program that helps alleviate that suffering is sinful.

    I’m not buying this, yet. I don’t hang around a lot at any church, but I don’t see this when I channel surf past tv evangelists, nor do I get whiffs of this from any relatives who are religious. I don’t see any of this in comments on the Web.

    That’s why they’re completely impervious to arguments about how food stamps or health insurance would make their lives better — if God thought they deserved that, He would provide it, not the government. To accept something God did not provide is a sin.

    There are plenty of folk of all denominations on food stamps. Also, religious sects which believe you are supposed to have tons of children have no problems taking food stamps and other government assistance, no matter how whacky their theology might be.

    With respect to health insurance, I just don’t know. Some of the objections seem to be from healthy people who don’t want to be forced into buying health insurance. And I don’t see religious seniors saying, “Can I give up my Social Security and Medicare so I can suffer”

  38. 38

    @Punchy: It isn’t policy; it’s comfort. The R’s offer protection from a world they have told everyone is dangerous.

    “We got Trouble. Right here in River City. With a capital T and that rhymes with P and that stands for pool!”

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