Why the Medicaid Waiver Plan Is A Bad Idea Skip to content

Why the Medicaid Waiver Plan Is A Bad Idea

3 min read

I just sent an email to the “comment line” for the proposed Medicaid waiver (kyhealth@ky.gov), outlining multiple reasons why the proposed changes are bad public policy, and why they will fail. Here’s the email I sent:


Hello! I am writing to let you know that I am OPPOSED to the Medicaid changes proposed by the Cabinet and Governor Bevin. Here is why:

  • Medicaid has always been a straight entitlement, based purely on income. The Medicaid waiver changes you propose introduce numerous ways that persons who are, indeed, poor, will nevertheless be shut out of receiving medical care, not because they have enough money to obtain their own care, but because of factors not related to income. This is not the original design, and is not how an entitlement works.
  • The rules and regulations that seem so easy to you are, in fact, hard for poor people. Simply getting from point A to point B can be a significant challenge. I know one man who worked a full-time job that required him to ride public transportation two hours in the morning to work, and two hours back home in the evening. Now you want him to figure out how to get to a local office that may not be served by public transportation. So he must spend $30 on a taxi in order to “check in.” You are adding burdens to people who already have enough burdens in their lives.
  • Many “able-bodied” Medicaid recipients are already working. Yet now you want to add a “check-in” every time their hours change. Apparently you’ve never worked in food service, where the hours can change each week. So now, a cook in a restaurant has to come “check-in” every week, because their hours might change every week. And if they don’t check in, they lose their benefits for six months. This is punishment for being poor, plain and simple.
  • You are taking a program that is already under-funded (and about to be significantly under-funded if Congress and the President have their way), and ADDING administrative overhead. This is going to be a highly manual process, with poor people showing up at offices all across this state, confused about the program’s new rules, and you are going to have to hire many, many new employees to administer this program.This program is going to fail simply because of the added complexity.
  • And finally, the Medicaid waiver smacks of Elites Know Better. It feels, very much, like you intend to teach the Undeserving Poor how to become Deserving Poor. The lack of connection with the real lives of many on Medicaid just smacks of arrogance.

Now, never let it be said that I wrote an email listing the problems, and didn’t also include some suggested solutions. So, here are some ideas for you to try:

  • Why not work from a standpoint of incentive rather than punishment? So, instead of punishing persons for not working, reward those who do with some sort of benefit: an Earned Income Credit, or additional credits for things not normally covered (like dental work). That way the entitlement stays in place for those who need it, but you are incenting persons to work, since that seems to be important to you.
  • The same for health outcomes. Why not incent people to take better care of themselves and need less care? Instead of having costs go down because you cut people out of the program, have the costs go down because the people are healthier. Radical idea: pay people to be healthier. One country (Sweden?) already does this: they calculate an actuarial basis for how much you should cost over the next year, and if you cost more, they still pay it; but, if you cost less, they give you part of the savings in a tax-free check. Might be interesting to see costs go down even with the monetary rewards!

Bottom line — We need to take care of our poorest and most vulnerable, not through shaming, not through punishment, but through incentives and a vision for a better future. Please do not become the State of Draconian Cuts; we can do better. Our people need us to be there for them.

Bruce Maples

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