Tribune-Courier General Manager
The expansion of Medicaid under federal health reform has greatly reduced the number of Kentuckians without health insurance, but state legislators are wary of the future cost.
In a recent meeting of the Interim Joint Committee on Appropriations and Reviews, Medicaid Commissioner Lawrence Kissner illustrated the impact of expansion with county-by-county maps to reveal the dramatic increase of insured Kentuckians this year as compared to 2012.
In Marshall County the increase is estimated between 6 and 7 percent of the population.
Enrollment in Medicaid has been larger than expected, and Kissner said he did not know how much the new enrollees will cost the state when it has to begin paying 3 percent of their cost in 2017. The payment amount will rise to the law’s cap of 10 percent in 2020.
Data comparing Medicaid reimbursements to hospitals across the state also reveal significant increases, with some reporting more revenue from Medicaid in the first six months of 2014 than during all of fiscal year 2013.
Marshall County Hospital has followed that trend, reporting Medicaid accounted for 13.4 percent of total patient charges January-June 2013 and up to 22.3 percent during the same period this year.
One of the reasons for the increased charges by hospitals, say healthcare leaders across the state, is a rise in emergency room visits for non-emergency reasons.
Marshall County Hospital has experienced a remarkable 49 percent increase in Medicaid emergency room visits during the first six months of this year as compared to last year, according to Marica White, Public Relations Director.
In 2013 Marshall County Hospital emergency room staff treated 791 Medicaid patients, with 1177 seeking treatment during the same period this year.
Jill Midkiff, spokesperson for the Kentucky Cabinet for Health and Family Services, says the misuse of emergency room services is not a new problem.
“Kentuckians suffer poorer health than many other Americans, and have traditionally utilized emergency rooms at a higher rate. This is not a new phenomenon,” Midkiff told Kentucky Health News.
She said Kentucky is working on the problem, focusing on so-called “super-utilizers” who use ERs several times a year.
Midkiff said emergency rooms have long been considered the “de facto primary care center,” noting people newly insured often don’t know how to use their benefits, which adds to people seeking treatment in ERs for non-emergency diagnoses.
“There is a steep learning curve to navigating the healthcare system and all providers and the insurance companies must help educate the newly insured,” said Midkiff.
Lawmakers have expressed concern about the growing cost of treating the newly insured.
“To hear the head of Meidcaid say we don’t have any idea whatsoever what we’re going to be paying, that’s very worrisome,” said Sen. Chris McDaniel, R-Taylor Mill. “I mean we’ve got tons of priorities in this state and it’s going to be a big number,” he said in an interview.
Democratic Gov. Steve Beshear has said the expansion will pay for itself by creating more jobs in, and tax revenue from, health care.