T he Case for Medicaid Expansion

1. The Case for Medicaid Expansion

2. Who We Are We’re a coalition of concerned Kentuckians, over 250 organizations and individuals, who believe that the best health care solutions are found when everyone works together to build them. Right now, families and businesses in every county are facing rising costs, and too many of us go without needed health care. Healthy families create healthy economies. And a healthy Kentucky is something we all want. So we’re working step by step to build a healthier Kentucky for everyone.

3. Our Key Priorities • Assuring that all Kentuckians have access to high quality, affordable healthcare • Making prevention a priority for Kentucky’s health policies and programs • Improving the efficiency and effectiveness of health care for Kentuckians • Improving the health of Kentucky’s children

4. Making the Case for Medicaid Expansion • Good for the Economy • Good for Health • Good for Kentucky

6. The Uninsured in Kentucky • 621,000 Kentuckians (14.4%) uninsured. Surveys highlight the challenges of Kentuckians who have no health coverage: • Three times more likely to skip needed care • Half did not fill a needed prescription • 40% did not see a specialist when needed • One-third reported using all or most of their savings to pay medical bills in the previous year

7. Unprecedented Opportunity for Coverage • In 2014, the ACA establishes a new national floor of Medicaid coverage at 138% of poverty level. • An estimated 329,000 uninsured Kentuckians would become eligible for Medicaid coverage if KY moves forward on expansion. • Kentucky would benefit from this expansion more than any other state as more than half (57%) of our uninsured population could receive coverage.

8. A Bargain for Kentucky • More favorable federal matching rate for expanding Medicaid (Current: 71% federal/29% state funds). • The federal government will pick up 100% of the state’s expansion cost until 2017, Kentucky will not have to expend any state funds for the first three years of the expansion. • The financialbottom line: Kentucky can take advantage of new federal funds without spending any state money from 2014 to 2017 for people in the expansion group. • State’s cost of the expansion in 2020 and beyond will only be 10 cents on the dollar.

9. Cost Savings for KY • Kentucky could save from $140 million to as much as $828 million from 2014 to 2019 by expanding Medicaid and implementing the ACA. • Reduction in uncompensated health care now provided to more than 600,000 uninsured Kentuckians.

10. Good for the Economy • An investment of $547 million in state funds will boost Kentucky’s economy and create jobs by bringing in more than $11 billion in additional federal Medicaid funding from 2014 to 2019 that will go to health providers. • Expanding coverage will also generate as much as $828 million in total savings because it will reduce the amount of coverage now provided to the uninsured that all of us have to pay.

11. States Must Take Action • Supreme Court ruled that the federal government could not cut off funding to states that refuse to expand the program, essentially making the expansion a state option. • Bottom Line: Kentucky must take specific action to expand Medicaid.

12. The Cost of Doing Nothing • The consequences of having an uninsured population affect every person in Kentucky. • When an uninsured person is unable to pay medical bills, the costs are absorbed by society in the form of higher charges to patients covered by private insurance (to offset uncompensated costs) and public programs that reimburse hospitals for uncompensated care. • The total annual costs associated with uninsured Kentuckians are estimated at more than $1 billion.

13. What is at Risk if Kentucky Doesn’t Act • Private health insurance premiums could increase • Premiums in health exchanges could increase • Employers will be at risk of penalties for uninsured employees • Kentucky hospitals are also at risk because more than $145 million in “disproportionate share” payments to hospitals that treat a large number of low-income patients will be reduced beginning in 2014.

14. Another problem is that a coverage gap or “Medicaid donut hole” will be created if Kentucky fails to expand Medicaid. Health benefit exchanges will begin operating in 2014 and will provide tax credits/subsidies to families with incomes above 100% of the federal poverty level. However, if Kentucky refuses to expand Medicaid eligibility to this income level, families with too much income to qualify for Medicaid and not enough to qualify for tax subsidies will fall in this coverage gap. Medicaid Donut Hole

15. Putting Kentuckians First • To effectively meet our health challenges, policymakers need to take action to expand Medicaid. • Medicaid expansion will provide health coverage to more than half of the 621,000 uninsured Kentuckians at only a fraction of the cost of the current Medicaid program.   • Failing to act will leave thousands of Kentucky families with no health coverage, forcing them to seek care in an emergency room or wherever they can with no way to pay the bill—costs estimated at more than $1 billion per year that all of us must eventually pay.

16. Join our collaborative advocacy efforts We need your voice to build a healthier Kentuckywww.kyvoicesforhealth.orgkvhexec@kyvoicesforhealth.org 502-882-0584