In Kentucky, Republican Gov. Matt Bevin is attempting an enormous transformation of Medicaid, one that would severely cut benefits and restrict access to the program. This would likely have a catastrophic effect on the health of low-income Kentuckians, and would effectively be a reversal of his Democratic predecessor's decision to expand Medicaid. So, what exactly is "MyRewards," the Kentucky Medicaid overhaul that may soon become law?
Bevin first announced the broad structure of the plan in June — which is called the "HEALTH" program — and The Courier-Journal recently got its hands on a more detailed outline of the proposal. Although many details haven't been finalized, it's clear that the overhaul would drastically cut health care access for low-income Kentuckians in several different ways. However, a press release touts Kentucky HEALTH as "a comprehensive plan to transform Kentucky’s Medicaid program, empowering individuals to improve their health and well-being while simultaneously ensuring Medicaid’s long-term fiscal sustainability in the commonwealth."
Under the new proposal, Medicaid recipients would have to pay premiums and co-pays as well as an $1,000 deductible, in order to receive health care; this directly contradicts the fundamental premise of Medicaid, which was created to serve as a government-subsidized program for the poorest Americans. But unfortunately, Bevin's plan goes further than that. It would also cut dental and vision coverage from Medicaid benefits but would allow recipients to "earn" them back by accomplishing certain tasks. This is the MyRewards system.
Under MyRewards, Medicaid recipients would earn "points" by fulfilling various requirements, such as passing a GED exam, agreeing to stop smoking, finding a job that will hire them to work 20 hours a week, completing a "weight management course," and others. If they are able to accrue enough points, they can use those points to purchase vision and dental coverage. It's sort of like a credit card rewards program, except that in this case, failing to accrue enough reward points could kill you.
In totality, Bevin's Medicaid proposal amounts to a massive cut to health care access for those who can't otherwise afford it. The plan needs to be approved by the federal government, specifically the Department of Health & Human Services, before taking effect; given that the HHS Secretary is Tom Price, an outspoken opponent of Medicaid, that approval seems likely. Bevin intends to implement it as soon as January 2018.
Requiring people to pay premiums, co-pays, and deductibles in order to receive incomplete health care coverage shouldn't be called "Medicaid," because that isn't how Medicaid works; it's how private health insurance worked prior to the Affordable Care Act. And if Bevin wants to eliminate government health care for the poor and replace it with a private insurance company, he should just say that.