FRANKFORT — Republican Sen. Julie Denton, the chairwoman of the Senate Health and Welfare Committee, Wednesday introduced bills requiring legislative approval before the governor can proceed with implementation of the Affordable Care Act or “Obamacare.”
But even if it passes the Republican Senate, it’s unlikely to go anywhere in the Democratic-controlled House.
The law was vigorously opposed by Congressional Republicans but after a Supreme Court ruling last summer that the law is constitutional and the re-election last fall of Barack Obama and a Democratic majority in the U.S. Senate, opposition has shifted to the states, especially those with Republican governors or legislatures.
One of Denton’s bills would require legislative approval before the governor could establish a health benefit exchange, an online site for people to shop for the most affordable health care plans, often with a federal government subsidy. If a state does not establish an exchange, then the federal government will do it for that state.
Denton’s other bill would require lawmakers’ approval before the governor could implement another provision of the ACA, to expand Medicaid rolls to cover those who still couldn’t afford health insurance, even with the subsidies.
While the Supreme Court ruled the overall law is constitutional, it ruled states cannot be compelled to expand Medicaid.
Gov. Steve Beshear has already begun establishing the health care exchange by executive order.
He said Wednesday that all “stakeholders in Kentucky – the insurance companies, the hospitals, the chambers of commerce – everybody prefers we have a Kentucky exchange run by Kentuckians as opposed to letting Washington, D.C., come in and run the exchange.”
Denton said, however, that the actual and long- term costs for the exchange, and especially for expanding Medicaid, are unknown and “one person should not be making this decision for the people of Kentucky.”
Senate President Robert Stivers, R-Manchester, agrees and he wants a thorough review and discussion before the exchange or Medicaid expansion is enacted. He is especially concerned about the costs for expanding Medicaid.
Under the law, the federal government would tax larger businesses which do not provide health insurance for employees and provide some subsidies to smaller companies to help them pay for employee insurance. It would also subsidize the purchase of private insurance for those who meet income guidelines and buy insurance through the exchanges.
But for those who still could not afford insurance, those who earn between 100 percent and 138 percent of the federal poverty line, states may enroll them in Medicaid and the federal government will pay 100 percent of the costs for the first three years and 90 percent thereafter.
House Speaker Greg Stumbo, D-Prestonsburg, said that’s too good a deal to pass up. And it’s the right thing to do, he said.
“Not only is it a good benefit to the state, it’s also something that I think morally we should do,” Stumbo said. He said once House members understand the federal government will pay most of the cost they won’t oppose implementation.
“I don’t think the House would be inclined to close the door on affordable health care for 400,000 Kentuckians who are currently uninsured,” he said.
But Denton and Stivers say it’s difficult to estimate those costs in the future.
“Do we have the resources to expand it even with the federal matches?” asked Stivers.
Beshear acknowledges cost is a problem.
“That’s what I’m looking at – to see long term whether I feel like Kentucky can afford to do that,” Beshear said.
“Obviously, if I determine we can afford to do it, I want to do it,” Beshear said, “because Kentucky is one of the unhealthiest states in the country.”
The Kaiser Foundation reported Kentucky would benefit from the law’s provisions more than any other state. Some of the unhealthiest communities in the country are located in eastern Kentucky, an area represented by Stumbo, Stivers and other legislative leaders like House Majority Leader Rocky Adkins of Sandy Hook and Senate Republican Whip Brandon Smith of Hazard.
“You want to make sure people have health care,” Stivers agreed. But he said it must be done “in the most feasible way and most reasonable way and take a rational approach to it and make sure you’re not having unintentional consequences.”
Beshear said if he decides to expand Medicaid, he won’t need the approval of the General Assembly.
“Medicaid eligibility is determined by regulation in the state health plan, I believe,” said Beshear. “If I made the decision to expand Medicaid it would be done by regulation.”