Let's separate Medicaid myth from fact
During my 14 years in the Kentucky House of Representatives, I was deeply involved in overseeing Kentucky's Medical Assistance Program better known as Medicaid. I co-chaired a committee that made an in-depth study of Medicaid that resulted in legislation that I sponsored to address waste, fraud and abuse.
Recently, Medicaid and its recipients have been misrepresented, resulting in divisive and misleading rhetoric. It is crucial that we examine the facts carefully and address the misinformation stemming from recent news reporting and pending legislative actions.
Medicaid funds do not go directly to recipients. Medicaid services prepay for medical care, such as doctor visits, procedures and medications to aid low-income families, children, parents, caregivers, pregnant women, seniors and people with disabilities.
The proposal in Congress to cut Medicaid by $625 billion over 10 years, leaving an estimated 7.6 million people without health insurance by 2034, along with the impending work requirements, suggests a lack of sensitivity or understanding regarding the nature of this program and the demographics of Medicaid recipients in Kentucky and nationwide.
Let's begin with a quick overview: Medicaid, established in 1965, is a public insurance program that provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors, and people with disabilities. It is funded jointly by the federal government and the states. Funds allocated for Medicaid do not go directly to recipients but are used to pay health care providers on a fee-for-service basis or through prepayment arrangements for medical care.
This includes doctor visits, medical procedures, medications and more. In Kentucky, the federal government pays about 70% and the state 30% of traditional Medicaid reimbursements while the match is 90% federal-10% state for expanded Medicaid, allowing Kentucky to provide 'significant health care services' at a good value.
Now let's look at the myth surrounding work requirements for Medicaid care. As the chair of the 1993 Program Review and Investigations Committee and principal sponsor of House Bill 127, an act relating to waste, fraud and abuse, I have consistently kept up with the Kentucky Medicaid Program over the years. It appears a long-standing misconception has produced an effort to create a solution for a problem that does not exist.
Full-time and part-time workers must rely on Medicaid and SNAP, a nutrition assistance program, because they do not earn a living wage to support their families. Maybe addressing this issue would help find a solution to the real, underlying problem we are currently facing.
Between 2015 and 2017, over 60% of Kentucky Medicaid recipients consistently held full-time or part-time employment. According to 2023 data from the Kaiser Foundation, Kentucky currently ranks 10th in the nation for the number of 'working Medicaid recipients.' There are 56.4% with full-time employment and 14.6% with part-time employment. Subsequently, 70.7% of Medicaid recipients are currently working, while 29.3% are not employed.
The non-working group comprises elderly individuals, people with disabilities, children and caregivers who together account for approximately 19.8%. These individuals do not meet any of the work requirements currently being proposed. Consequently, the legislative proposals being considered would only affect 9.5% of the remaining Medicaid population here in Kentucky — undoubtedly, a solution for a problem that does not exist.
Work requirements put up barriers to Medicaid coverage. Changes to work and reporting requirements and eligibility criteria have been shown to cause confusion among Medicaid enrollees, leading to substantial coverage loss, even for those who are eligible.
A 2022 Kaiser Family Foundation report revealed that nearly 70% of people who had been dropped from Medicaid lost coverage due to procedural reasons. This is just the latest evidence of the harmful impact on peoples' access to health care caused by recent changes in Medicaid policy. During the time studied, Kentucky disenrolled 71,000 enrollees for missed paperwork and other procedural reasons. Of these, 74% (52,540) lost coverage attributed to barriers created by the beginnings of a state Medicaid work requirement that a court blocked from taking full effect, while 26% were found ineligible. As a result, 52,540 individuals lost access to health care services.
Clearly, any barriers affecting Kentucky's Medicaid recipients warrant reevaluation. Our diligent Medicaid recipients merit equitable treatment and consideration.
However, Houston, we do have a problem: Kentucky reported that in 2022, half of working Medicaid enrollees (50%) were employed by companies with over 100 employees and 42.8% worked in the agriculture/service sector. These full-time and part-time workers must rely on Medicaid and SNAP, a nutrition assistance program, because they do not earn a living wage to support their families. Maybe addressing this issue would help find a solution to the real, underlying problem we are currently facing.
The Congressional Budget Office's analysis shows that this 'one big, beautiful bill' will reduce expansion reimbursements, add additional cost to Medicaid recipients, add work requirements, increase coverage barriers, cut Medicaid spending by $625 billion over 10 years, and leave at least 7.6 million more people without health insurance by 2034.
True leadership involves building bridges, not barriers.
Jack L. Coleman, a Democrat from Harrodsburg, represented Kentucky's 55th House District from 1991 to 2005. As co-chair of the legislature's Program Review and Investigations Committee, he helped lead a study of Medicaid that included findings and recommendations concerning financial accountability, recovery and drug utilization. In 1996, he sponsored House Bill 127, an act related to Medicaid waste, fraud and abuse, based on the results of the study. The bill served as a companion to Senate Bill 37, sponsored by then-Sen. Susan Johns, co-chair of the program review committee.
Coleman is the father of Lt. Gov. Jacqueline Coleman.
SUPPORT: YOU MAKE OUR WORK POSSIBLE
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Axios
an hour ago
- Axios
Texas is one of most restrictive states for birth control access
Texas is among states with the most restrictive access to contraception, a new scorecard from the Population Reference Bureau shows. Why it matters: Contraception access has become a political flashpoint since the U.S. Supreme Court ended Roe v. Wade, with Democrats unsuccessfully pressing to codify contraceptive access nationwide and some patients concerned that conservative state legislatures could enact new curbs. Zoom in: While Texas expanded Medicaid coverage for family-planning services through the Healthy Texas Women waiver, it hasn't adopted a broader expansion of the health insurance program for low-income residents. That has left gaps in coverage for men and people under 18, per the scorecard. The state requires insurers to cover prescription birth control if they cover other prescription drugs but doesn't mandate coverage of over-the-counter methods. Texas allows minors to consent to contraceptive services only if they're married or meet narrow exceptions. Texas also doesn't require sex education in schools, per the report. The big picture: Nearly 35% of Americans, or 121 million people, live in a state that actively restricts access. The most protective states included California, Washington, Connecticut, New York, New Mexico, Maryland and Oregon. What they're saying:"Reproductive health care access depends on where you live," said Cathryn Streifel, senior program director at PRB and co-author of the scorecard.
Medscape
2 hours ago
- Medscape
PEPFAR Spared, but Concerns About Global HIV Response Remain
Experts are expressing relief that the US President's Emergency Plan for AIDS Relief (PEPFAR), a $7.5 billion program credited with saving 26 million lives around the world from HIV, was spared millions of dollars in spending cuts. Last week, the US Senate removed a proposed $400 million reduction in PEPFAR funding from the $9 billion rescission package put forward by President Donald Trump after objections from Democrats and a handful of Republicans. The PEPFAR program, which was set up by President George W. Bush in 2003, provides treatment to two thirds of all patients with HIV across more than 50 countries and has allowed almost 8 million babies to be born healthy to mothers with HIV. 'This isn't a full reset, but it's meaningful,' Jirair Ratevosian, DrPH, a former senior advisor to PEPFAR, told Medscape Medical News. Members of both parties in Congress have found the administration's justifications for the cuts to be deceptive, he added. The blocking of the cuts is 'also a sign that Congress is willing to exert oversight and send a clear message globally: The US is not walking away from the HIV fight.' Ratevosian is an associate research scientist at Yale University in New Haven, Connecticut, with a primary focus on HIV prevention. 'It gives PEPFAR breathing room to continue planning country transitions — something the Trump administration claims to prioritize — and to support innovative programming, including HIV prevention using AI [artificial intelligence],' Ratevosian said. PEPFAR's Future Uncertain But while activists and experts welcomed the news, the future of the program remains uncertain. It is now administered by the US State Department, with little detail about how and where services will be delivered. 'The decision is a testament to the power of global health activism, but it is important to realize that all this does is ensure that $400 million that had already been allocated to be spent on fighting HIV doesn't get spent by Trump,' Asia Russell, executive director of Health GAP, an international organization focused on access to HIV medicines, told Medscape Medical News. Some organizations that are implementing PEPFAR have taken Trump's budget cuts to indicate that they should stop intervening among priority populations like trans patients, gay men, and sex workers. 'Any effective infectious disease response must focus on communities who have an elevated risk of HIV acquisition or poor clinical outcomes.' In a recent report, the Joint United Nations Programme on HIV and AIDS (UNAIDS) said that the weakening aid consensus and significant and abrupt funding shortfalls in the HIV response had triggered widespread disruption across health systems, halting HIV prevention programs and jeopardizing treatment services. UNAIDS predicted an additional 6 million new HIV infections and 4 million additional AIDS-related deaths worldwide between 2025 and 2029 resulting from the collapse of US funding. Ukraine has an estimated 245,000 patients with HIV, which is the second highest prevalence in Europe after Russia. Dmytro Sherembey, head of Ukraine's largest patient-led HIV organization, 100% Life, told Medscape Medical News that his organization had been forced to cut its expenses by 30%. He credits his own survival of HIV to US aid. 'These past few months have been incredibly difficult. Amid the war in Ukraine, we faced the terrifying risk of losing essential funding from PEPFAR. Prevention, awareness, advocacy, and community support programs — key drivers in the HIV response — were hit the hardest,' he said. 'The decision [not to cut funding] brings hope and stability. It means children won't lose parents, parents will have healthy babies, and people in Ukraine will keep accessing life-saving care.' Additional Threats Remain In April, UNAIDS said that Ukraine's national preexposure prophylaxis (PrEP) program was at high risk because of halted procurement. Its current supply is expected to be exhausted by mid-August 2025. 'In Ukraine, we count on the US decision that PEPFAR will continue to fund PrEP,' Andriy Klepikov, PhD, executive director of the Alliance for Public Health, told Medscape Medical News. The Alliance for Public Health is one of the largest HIV-focused nongovernmental organizations in Ukraine and the wider region. Andriy Klepikov, PhD 'We hope that PEPFAR will continue PrEP for key populations (not only for pregnant and breastfeeding women), but there is no confirmation yet,' he added. But while PEPFAR has been spared, additional threats to the global HIV response remain. The United States Agency for International Development (USAID) has been dismantled, the administration has cut nearly $1 billion in HIV funding at the National Institutes of Health, and the CDC's Division of HIV Prevention has been cut significantly. 'There's no sign that the funding of USAID will be restored. Much of the local support for HIV was funded by USAID, such as HIV testing, outreach workers, and support for key populations,' said Andrew Hill, MD, PhD, senior visiting research fellow in the Department of Pharmacology and Therapeutics at the University of Liverpool, Liverpool, England. Andrew Hill, MD, PhD He cited a recent The Lancet paper that suggested that ongoing deep funding cuts could result in more than 14 million additional deaths by 2030. 'If 14 million people do indeed die early as a result of US cuts, this would be the greatest loss of life from any US presidency since World War II.'
Indianapolis Star
2 hours ago
- Indianapolis Star
An Indiana hospital cut medical services. A new DNC billboard blames President Trump
A new billboard on the southeast side of Columbus paid for by the Democratic National Committee blames President Donald Trump for recent medical service cuts at Columbus Regional Health and is part of a multi-state campaign to show Trump-voting communities what the party views as negative effects to rural health care in the 'One Big Beautiful Bill.' The Indiana billboard, which was installed July 22, is one of four billboards the DNC unveiled addressing hospitals that are closing or cutting medical services across the country. In addition to Indiana, the DNC launched billboards in Missouri, Oklahoma and Montana. A spokesperson told IndyStar the party paid 'four figures' for the Indiana sign. All four billboards are bright yellow with messages in bold black lettering specific to a health care provider in each state. 'Under Trump's watch, Columbus Regional Health is cutting medical services,' the Columbus billboard reads. It directs passersby to a page on the DNC website with state-by-state impacts of the president's tax and spending cuts bill that was signed into law on July 4. Democrats and advocacy groups have decried the large cuts to Medicaid included in the bill through work requirements and an eventual decrease in the cap on provider taxes from 6% to 3.5%. Indiana relies on those taxes, paid by hospitals, to fund its Medicaid expansion program known as the Healthy Indiana Plan. Columbus Regional Health on June 30, prior to the bill's passage, announced it would close its inpatient rehabilitation unit and outpatient orthopedics and sports medicine services, which the organization said was due to no longer being able to 'cost-effectively provide inpatient rehab services.' The June announcement said some of the cost concerns are due to rising supply costs, 'legislative scrutiny' and state and federal funding cuts. In a statement to IndyStar on July 22, Columbus Regional Health said it was unaware of the DNC billboard and did not provide permission to be referenced. 'Recently, Columbus Regional Health made the announcement of service line and practice closings related to increasing financial constraints and burdens our health system is currently facing," the statement reads. 'These difficult decisions were made under consideration of the many challenges and risks facing not just CRH – but many hospitals, health systems, and medical providers statewide and nationally – in order to remain financially viable.' A $50 billion fund to support rural hospitals was added to the Trump's "One Big Beautiful Bill" toward the end of negotiations between lawmakers to appease senators who were concerned about the size of the proposed Medicaid cuts. But some health policy groups say it's likely not enough to help ease the impact of federal funding losses from the changes to Medicaid in the bill. Indiana could receive some amount of money from $25 billion of the rural health fund dedicated to states that submit applications with the Center for Medicare and Medicaid Services. The CMS Administrator is expected to have flexibility to distribute the other $25 billion. Taxes to Medicaid: 4 ways Trump's 'Big Beautiful Bill' could impact Hoosiers A June letter to Republican leaders from four Senate Democrats argued that Trump's tax and spending cuts bill would put 12 rural Indiana hospitals "uniquely at risk" of closure or cutting services. But the letter, based on data from the Sheps Center for Health Services Research at the University of North Carolina, was sent out before the rural fund was added to the bill. An analysis from the Kaiser Family Foundation, though, found that the rural health fund only offsets about one third of the federal Medicaid funding rural areas around the country are expected to lose under the bill. Scott Tittle, the president of the Indiana Hospital Association, said in a statement to IndyStar that he is also concerned the rural fund will not be enough to cover expected losses for hospitals in Indiana and that the fund itself is temporary. 'There is no additional assistance following the end of the OBBBA's five-year period,' Tittle said in the statement. In a news release about the billboards, DNC chair Ken Martin said Trump 'put the last nail in the coffin for rural hospitals' and that Trump's voters 'will suffer the most.' Nearly 63% of voters in Bartholomew County, where Columbus is located, voted for Trump in the 2024 presidential election. "After blowing a lethal hole in rural hospital funding, Republicans are about to find out that their flimsy funding band-aid won't be enough to protect them from voters' righteous anger,' Martin said. 'These new DNC billboards plainly state exactly what is happening to rural hospitals under Donald Trump's watch.' Contact IndyStar state government and politics reporter Brittany Carloni at
