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Medicaid Expansion: Kentucky governor explains his state's success

Medicaid Expansion: Kentucky governor explains his state's success

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Critics of Medicaid expansion in Virginia who reference Kentucky’s experience with federal health care reform should beware: Our success undercuts your whole opposition.

Having proved from the beginning that health care reform is both the right thing and the smart thing do, Kentucky has become the poster child for why states should expand Medicaid.

The July 29 editorial in the Richmond Times-Dispatch (“Soaring costs”) fails to grasp both the moral and economic arguments for expansion. After a convoluted discussion of future costs and speculation about whether Congress might reverse course years from now, the editorial saved for its last paragraph, perhaps as an afterthought, this grudging admission about the Affordable Care Act:

“True,” the editorial read, “people who lacked insurance now have coverage, enabling them to get the care they need. That’s an important social good, and should not be discounted.”

Talk about an understatement.

The core tenet of health care reform is helping families and saving lives. Not vague political theory, but helping people. That’s what we’re doing in Kentucky. It’s a Christian thing.

Kentuckians’ collective health has long been among the worst in the nation, ranking at the bottom in almost every health category. That’s had a negative impact on our quality of life, workforce, economy and state government finances.

Poor access to care is partly to blame. Back in 2013, we had about 640,000 people without health insurance.

But health care reform has given us a transformative opportunity to attack this weakness. Ever since Kentucky put politics aside and both expanded Medicaid and created our private insurance exchange — called “kynect” — we have reduced our uninsured rate by almost 56 percent, from 20.4 percent to 9 percent, according to a Gallup Poll.

States that took both those steps on average reduced their uninsured by 44 percent. In states that resisted reform, the reduction was only 28 percent. And then there’s Virginia, whose uninsured rate fell just 6 percent, from 13.3 percent to 12.5 percent.

The long-term impact for Kentucky will be a healthier and more financially secure population.

New data show that Kentuckians on Medicaid are far more likely to get cancer screenings, physicals and dental checkups. Since expansion, breast cancer screenings are up 111 percent, cervical cancer screenings are up 88 percent and colorectal screenings are up 108 percent. Likewise, preventive dental services were up 116 percent, physical exams up 187 percent and more recipients got cholesterol screenings, flu shots and diabetes screenings.

Kentucky residents no longer have to choose between medicine and food, skip checkups or ignore troubling signs, such as a lump or pain, praying that those don’t develop into a chronic disease or fatal illness.

As far as expansion being the “smart” thing to do, an independent analysis of Kentucky’s first year under Medicaid expansion shows clearly what a good deal this is financially, both now and for our economy, long term.

The analysis — by Deloitte Consulting and the University of Louisville Urban Studies Institute — studied actual performance data. It backed up a similar study I commissioned in 2013 before I made the decision to expand Medicaid — and, if anything, it demonstrated that our 2013 projections weren’t rosy enough. In short:

  • More than 12,000 health care-related jobs were created in the first year alone. Not coincidentally, Kentucky’s overall unemployment rate has fallen 37 percent since January 2013. In the same time period, Virginia’s rate declined only 16 percent.
  • The updated study predicted a $30 billion positive impact on Kentucky’s economy over eight years because of that expansion.
  • Speaking directly to “affordability,” the report predicted a positive net impact of $819.6 million over eight years on state and local governments — even after the state match for Medicaid costs is phased in. Yes, the “monstrous hole” mentioned in the editorial has already been taken into account.
  • And finally, health care providers in Kentucky received at least $1.16 billion in new Medicaid revenues in 2014.

And those numbers don’t even address the societal impact of improved health on quality of life or economic capacity, or tangible things, such as worker productivity, school attendance and public image.

So, to those who claim states can’t afford expanded Medicaid, I say this: You’re entitled to your own opinion, but you’re not entitled to your own facts. The facts in Kentucky demonstrate that not only can states afford to expand Medicaid, but they also really can’t afford not to do it.

Especially if they care about their people.

Steve Beshear is governor of Kentucky. Contact him at

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