This morning, Glenn Kessler of the Washington Post joined the parade of pundits calling shenanigans on Mitch McConnell’s claim that Kentucky’s state health insurance exchange, Kynect, is somehow “unconnected” to the Affordable Care Act. “It is not credible for McConnell to suggest that the state exchange would survive without the broad health-care system constructed by the Affordable Care Act,” Kessler writes, calling McConnell’s position on the matter “untenable.”
Kessler is spot-on accurate on this point, but there was another point he made that didn’t quite sound right. “McConnell appears to have accepted the Medicaid expansion that has been so embraced by his state’s residents,” Kessler wrote, calling this development “newsworthy.” Indeed it would be quite a moment if the leading Senate Republican were to cave on Obamacare’s expansion of Medicaid, but I don’t think that’s what happened.
Kessler drew this conclusion from his correspondence with McConnell’s campaign manager, Jesse Benton. He asked Benton if McConnell would support federal funding for expanding Medicaid even if the law were repealed, and Benton responded:
Medicaid existed before Obamacare and will exist if we are able to repeal it. Obamacare loosened eligibility requirements for Medicaid recipients, and in the process, helped find many who were already eligible but no [sic] enrolled. These people would remain eligible even after a repeal. The federal government does allow states flexibility in setting requirements and Kentucky could be able to keep many of the newly enrolled in the program if we decided to.
The first three-fourths of Benton’s response was not germane to Kessler’s question. Benton was describing what health policy nerds call the Woodwork Effect – people who were unaware that they were eligible for regular, non-expanded Medicaid “came out of the woodwork” once ACA publicity drives kicked in. Federal funding for expanding Medicaid covers 100 percent of the cost for enrollees who meet the new, looser eligibility guidelines (dropping to 90 percent after 2016), but it does not cover the “woodwork” enrollees. For them, the feds will cover 71 percent, with Kentucky picking up the remaining 29.
Things get interesting when Benton muses on the post-repeal Medicaid situation in Kentucky: “The federal government does allow states flexibility in setting requirements and Kentucky could be able to keep many of the newly enrolled in the program if we decided to.” This hypothetical is a fairly weak attempt to paper over the fact that McConnell’s position is to strip the state of the extra federal funding that was the primary incentive to expand Medicaid in the first place.
Benton is saying that maybe a situation could be hammered out where “many” – not all – of the newly eligible enrollees could be kept on Medicaid, “if we decided to.” That’s hedged to the point of near-meaninglessness, and he’s focusing on eligibility while carefully avoiding the key issue of funding. Presumably, if Obamacare were repealed and expanded federal funding cut off, Kentucky would have to cover 29 percent of the costs for the newly eligible enrollees, rather than the 0-10 percent that it will cover under the ACA.
If this is what Team McConnell’s position is, then they’d be arguing for less coverage than is available under the ACA at a higher cost for the state. Color me skeptical. My guess is that Benton got a little too cute in trying to cover for his boss’ incoherence on Obamacare.