Kentucky's next governor: I'll scrap traditional Medicaid expansion

Also says he will wind down state-run exchange

Josh Zeitlin, Associate Editor

Tuesday's election results have major implications for health care in Kentucky and Virginia—and Louisiana's gubernatorial election later this month also could have high stakes for the industry. Here's what you need to know.

Kentucky

In what many considered an upset, voters elected Republican Matt Bevin to be the next governor of Kentucky, beating Democratic candidate Jack Conway by nearly nine percentage points. Bevin will take office on Dec. 8.

The state has been hailed as an Affordable Care Act success story and experienced the largest drop in the rate of uninsured residents of any state last year, according to the U.S. Census Bureau. Current Gov. Steve Beshear (D) is a major proponent of the health law and used executive orders to expand Medicaid and launch a state-run exchange.

But because of the way those initiatives were established, Beshear told National Journal in an interview earlier this year, "a governor who wanted to abolish the program could very easily do it."

Bevin says he will close Kentucky's state-run exchange, known as Kynect. He told the Cincinnati Enquirer last week that he would use the 2016 open enrollment period to transition state residents (who would need to re-enroll) to the federal exchange and then would shutter the state-run exchange.

Kentucky hospitals: The ACA has hurt us more than it has helped us.

Bevin's position on Medicaid expansion slightly shifted during his campaign. In February, Bevin pledged to halt the state's traditional expansion "immediately," but by September, he'd begun to champion a different approach—pursuing an alternative expansion plan via a federal waiver that would require beneficiaries to pay a portion of the premiums.

Bevin specifically pointed to Indiana's alternative Medicaid expansion as a model.

Bevin campaign spokesperson Jessica Ditto told National Journal that "the goal would be to get a waiver approved prior to 2017, when the state starts to pick up our share of the Medicaid expansion," but she acknowledged "that is a lofty goal, given all the moving parts and the need for insurance companies to develop new plans based on new standards."

Virginia

In other election news, on Tuesday Virginia Republicans held the state Senate, dealing a blow to Gov. Terry McAuliffe's (D) efforts to expand Medicaid in the state.

Bribery allegations fly in Virginia's fight over Medicaid expansion

Entering the election, the GOP held a substantial majority in the state House of Delegates but only a one-seat majority in the state Senate. Some experts told Modern Healthcare that a Democratic-controlled state Senate (or a split chamber, with the Democratic lieutenant governor to break ties) would bolster the chances of Medicaid expansion.

However, no state Senate seats flipped to Democrats (or vice versa), and Republicans retained their control of the chamber.

Louisiana

One race that remains on the radar for Medicaid expansion: Louisiana's Nov. 21 runoff election for governor between Sen. David Vitter (R) and state Rep. John Bel Edwards (D).

Edwards says he would enact a traditional Medicaid expansion on "Day One."

But Vitter says he would only expand Medicaid if he can seek a plan via a federal waiver, and he wants to require beneficiaries to be employed to be eligible for coverage. Several sitting governors made similar requests of CMS—which were rejected.

Vitter says he wants a more detailed plan about how providers would pay for the costs of expansion. The Louisiana Hospital Association's (LHA) members extended an offer to cover the state's portion of the expansion beginning in 2017 via a fee charged to hospitals, but Vitter says he is concerned that the funding plan as currently designed would not fully cover the costs.

LHA placed an April 1, 2016, deadline on expansion for its funding offer to apply. LHA President Paul Salles told the Times-Picayune, "We're open to discussing with a new administration other options going forward, but that was the timeline we thought was important to create some urgency."


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