BOWLING GREEN, Ky. (AP) — Bobby Paisley's health insurance covers his vision and dental care. He knows, because he and his wife pay for it.
"I don't have to do community service, I don't have to earn points and I don't have to wait," he said.
But that's exactly what some 400,000 Kentuckians would have to do if they need an eye exam or a tooth pulled under Gov. Matt Bevin's proposal to overhaul the state's Medicaid program. Bevin's plan, announced last week, would eliminate dental and vision coverage for able-bodied Medicaid beneficiaries, but they could earn those benefits back by getting a job, volunteering for a charity or taking a class at a community college.
Bevin calls it "community engagement," saying it is key to inspiring Kentucky's Medicaid beneficiaries to take control of their health and save the state money. But for Paisely and about 150 advocates and consumers who showed up in Bowling Green on Tuesday for the administration's first public hearing on the plan, Bevin's proposal would do more harm than good.
"I find it to be a little discriminatory," Paisley said. "I feel like we are alienating a sector of the market because they are impoverished and don't have the ability to pay for health coverage."
Kentucky was one of 32 states that expanded its Medicaid program under President Barack Obama's Affordable Care Act. As a result, about 400,000 people got health insurance in Kentucky, dropping the state's uninsured rate to 7.5 percent from 20 percent, among the largest drops in the country.
Kentucky taxpayers will begin paying for a portion of that expansion beginning in January. It's expected to cost $257 million over the next two years. Bevin, a Republican who took office in December, says the state can't afford it, noting the state's Medicaid program is already running at a $700 million loss. He plans to ask the federal government for permission to change the state's Medicaid program, with the goal of moving people off government assistance and into the private insurance market.
The federal government must approve any Medicaid changes, and Bevin has said he wants to submit it for federal review by Aug. 1.
So far, federal officials have been unwilling to approve work requirements as a condition for receiving benefits, most recently in Indiana, which Bevin cited as a model for his plan. Last week, Bevin said he is willing to negotiate with the federal government, but that if his plan is not ultimately approved he will repeal the expanded Medicaid program completely.
Health care advocates and providers worry Bevin's proposal will take away health insurance from the people who need it the most. Of the 22 people who spoke Tuesday on the campus of Western Kentucky University_mostly providers and advocates_none supported it. Many criticized Bevin for wanting to eliminate dental coverage. Right now, Medicaid pays for things like fillings and tooth extractions. Those would be eliminated for able-bodied adults under Bevin's plan, offered only as an incentive for completing various community engagement tasks. Other perks for completing certain tasks include gym memberships.
"It is comical to place dental care on the same level as a gym membership," said Brandon Taylor, a dentist who said Medicaid patients make up 92 percent of his nonprofit clinic in Owensboro. He said he Medicaid lets him charge $40 to pull a tooth, while a visit to the emergency room would cost more than $750.
Vickie Yates Brown Glisson, Bevin's secretary of the Cabinet for Health and Family Services, said she did not consider the hearing to be "a backlash" against the proposal. She called the comments "legitimate questions" and said hopes to address them. She emphasized the proposal would not affect beneficiaries who are disabled or participate in a Medicaid waiver. And she defended the work or volunteer requirements for able-bodied adults.
"We want to encourage individuals to be able to take charge of their own health care as much as possible," she said.
This story has been corrected to say about 150 people attended the hearing, not several hundred.