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Shelby’s Medicaid expansion impact: Perhaps 2,800-plus

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Positions differ for JHS, Mercy Medical officials

By Todd Martin

With Gov. Steve Beshear’s announcement Thursday to take advantage of President Barack Obama’s Affordable Care Act and expand Medicaid in Kentucky, more than 2,800 uninsured Shelby Countians in 2014 will become eligible for the federal- and state-funded health care.

Another 3,128 would become eligible for subsidized insurance through the Health Benefits Exchange.

The expansion of Medicaid will make coverage available to those making up to 138 percent of the federal poverty level. That means a single adult making less than $15,856 and a family of four earning $32,499. Those earning between 138 percent and 400 percent without health benefits would be eligible for the Health Benefits Exchange.

Kentucky is one of 22 states adopting the Medicaid expansion

Beshear, in a press conference, called this move one of the easiest he has had to make.

Citing a study by the Cabinet for Health and Family Services, Beshear claims that the expansion will help create nearly 17,000 jobs in Kentucky and have a positive impact of more than $15 billion through 2021. The study also showed a positive impact of more than $800 million on the state budget over the same timeframe. Without expansion, the study shows an increase of almost $40 million in state spending.

The majority of Shelby County residents under 65, 81.1 percent, are insured, but the other 18.9 percent would qualify for some relief under the expansion.

There would be no cost for the first three years, as the federal government picks up the cost for expansion. After that, the federal government’s portion decreases to 90 percent by 2020.

Currently, the state pays 30 percent for traditional Medicaid qualifiers, both poor and disabled, and those qualifying by earning less than 100 percent of the federal poverty level.

Good for JHS?

Because its goal is to provide greater access to health care, the Affordable Care Act calls for a reduced amount to be paid to hospitals in Disproportionate Share Hospital (DSH) payments, which reimburse hospitals for uncompensated care.

According to Beshear’s report, Shelby County received almost $1.4 million between 2010 and 2012 and is estimated to receive more than $425,000 more this year. Those payments will decrease by more than $14,000 next year and by almost $117,000 by 2020.

Michael Collins, president of Jewish Hospital Shelbyville, said in a statement that JHS officials expect the DSH payments to decrease and that the expansion of Medicaid will be a benefit to the community.

“Our hospital, along with our local health department, has completed a community health assessment to evaluate the health-care needs of our most vulnerable populations,” Collins said.

Collins cited Census Bureau data that indicates that in Shelby County, 18.9 percent of the county’s population below the age of 65 is uninsured. The data also says that 26.8 percent of residents at or below 400 percent of the federal poverty level are uninsured.

“We believe the expansion of Medicaid is certainly good news for these citizens, who will now have the opportunity to proactively manage their health,” he said.

Mercy’s growing load

However, Jim Kutzner, clinic administrator at Mercy Medical Clinic on Washington Street in Shelbyville, which provides free health care to those who make up to 200 percent of the poverty level, a little more than $16,000 for a single adult, and have no other insurance coverage, said he isn’t sure what the effects of the expansion would be.

“In theory, the number of patients we serve should go down, but people may still not be able to see a doctor,” Kutzner said. “Most doctors are not accepting any new Medicaid patients.”

Mercy Medical had more than 4,400 patient visits in 2012, up about 1,000 from 2011, and early signs indicate an even bigger increase this year.

“In January of 2012, we saw three hundred and two patients, and this January we saw four hundred and seventy-one patients. We’re on pace for more than five thousand visits this year. And some experts think we could start seeing more people with the expanded Medicaid.”

Kutzner said Mercy Medical sees only patients with no insurance, and only those that make up to 200 percent of the poverty level, a little more than $16,000 for a single adult.

“I’ve had seven calls this week – calls I’ve never gotten before – that were people with insurance that couldn’t afford their co-pays and wanted to know if they could come here,” he said. “That’s not something we offer now, but it might be something we have to look at in the future.”

Kutzner said his opinion is we could see a big increase in emergency room visits.

“That’s something we’re actively trying to reduce,” he said. “Most of the people we see, they would end up in the emergency room.”

Wait and see

In the field of free and reduced medical clinics, Kutzner said there are still too many questions that no one can answer.

“I was at a conference in the fall, and even among the experts at the federal level, their answer was, ‘I don’t know,’” he said. “In the short-term, I think it’s going to be kind of chaotic. People are going to be happy that they have insurance, but when they see there is an out-pocket-expense, they’re not going to be able to pay for it.”

For instance, many of the people that Mercy Medical serves, he said, can’t afford the $10 co-pay the clinic requests.

“Of course, we don’t’ refuse medical care to anyone if they can’t afford, because most them can’t,” he added. “Like almost everybody else, we’re wondering where the money for this is coming from, and we’ll just have to wait and see.”