My Old Kentucky Podcast Show Notes, 8/28

KY Medicaid 1115 Waiver

What is Medicaid?

  • Means tested government health insurance
  • Administered by State governments but paid for by both state and federal government.

ACA and Medicaid

  • When “Obamacare” passed, a big part of the plan was to COMPEL states to expand Medicaid to all individuals who make up to 138% of the federal poverty line.
  • The federal government would pay for 100% of this expansion for 3 years, and 90% of the funding on an ongoing basis.
  • When the Supreme Court upheld the ACA, the one piece it did change was it did not allow the federal government to compel states to expand Medicaid — that part became optional.
  • Many states opted to expand medicaid, and others decided NOT to expand Medicaid, but 6 states with more moderate governments were given the option to do a “Section 1115 Demonstration”: IN, MI, IA, AR, VT, MT. These demonstrations are essentially experiments of different ways to do Medicaid.
  • Items in these demonstrations include charging premiums/other cost sharing, HRA programs, wellness programs, and a few others.

Medicaid expansion in Kentucky

  • Kentucky’s Medicaid is a thing called “Managed care”. This is when the business is bid out to private companies (Passport, Coventry, etc).
  • Steve Beshear expanded Medicaid in 2014. Essentially, it opened the existing program to more people. 310,000 Kentuckians gained insurance through the expanded Medicaid program

Matt Bevin and Medicaid

  • Matt Bevin is no fan of Barack Obama or his priorities. He campaigned explicitly against the ACA.
  • His plan is to remove the blanket expansion of Medicaid and to put Kentucky into of the Section 1115 waiver demonstrations.
  • I read most of the waiver document, but I’ll quote Health Affairs for a summation of the elements in the waiver: “1) monthly premiums that increase over time; 2) a volunteer or work requirement; 3) eliminating benefits including vision and dental care and non-emergency medical transportation, ostensibly to make Medicaid more like a commercial insurance plan; and 4) an incentivized “My Rewards” account in which credits would be accumulated for approved behaviors such as community service or work and debited for behaviors deemed inappropriate such as non-urgent emergency room (ER) use. The credits in this account could be used to purchase back services that are no longer covered.”
  • Matt Bevin said he would repeal the entire Medicaid expansion rather than stick to the old version. (He can Probably do this. Cara Stewart and Al Cross had a good twitter conversation around this).


Bevin and Boards

University of Louisville

  • Abolishes entire board and announces Ramsey to resign
  • The new board meets, Ramsey does a presentation, leaves meeting, then doesn’t resign
  • Junior Bridgeman gives fumbling interview and admits to violation of open meetings?
  • Later says, Ramsey did offer resignation, we just haven’t decided to accept it. They later do accept it.
  • Ramsey DOES resign, remains president of foundation, which is where his salary comes from
  • Law=17 members, Bevin appoints a board of 10
  • Sheperd: needs to be a hearing
  • Law=removal for cause after a hearing
  • Bevin using a reorganization statute, saying it’s not removal
  • Irreparable harm-accreditation issues, but I think focus in the opinion is on the substantial question of law
  • “any university trustee or group of trustees, can be removed for no reason or any reason — good or bad, well-intentioned or malicious.” The governor could even unilaterally merge U of L with the University of Kentucky, Shepherd said.
  • Bevin appealing, abuse of discretion and misapplying the law, no accreditation issues

Kentucky Retirement System

  • Tommy Elliott: Chair of KRS, removed three years before term ended
  • Term set by statute
  • Violation of statute and separation of powers?
  • 63.080: Any person appointed by Governor can be removed for any cause governor deems sufficient
  • AG opinion: can’t remove without cause when term set by statute (4 years in Elliott’s case)
  • When he showed up at board meeting, met by Bevin staff and KSP threatening arrest
  • “Lawless strong arm tactics”
  • “Flagrant abuse of executive power”
  • Abolished and reorganized in June
  • Judge Sheperd held that Elliott should remain on the board while case is pending, denied request to block Bevin’s overhaul
  • 1) injury 2) equity 3) legal question
  • It does not reinstate but it blocks the appointment of Mark Lattis
  • No irreparable harm in allowing the reorganization and no harm to public interest, appointed competent and qualified individuals
  • Judge Shepard suggests that Elliott may be entitled to a hearing before removal
  • No controlling precedent re: removal before term
  • Bevin appealing ruling: Elliott shouldn’t be on a board he was never a member of


Jim Gray’s Senate Race

  • There is a race for US Senate in Kentucky this election, between Rand Paul and Jim Gray. Gray won the primary against Sellus Wilder, who was seen as more progressive but who had much less money.
  • The national media has all but given this race over to Paul. The Upshot, the New York Time’s data vertical, has the odds at 94% for Rand Paul. Prediction markets and the Princeton Election Consortium (Sam Wang) have the race pegged as a slam dunk for Rand Paul as well.
  • There have been two polls from local firms. One is from a Republican group that showed Rand up 50–38, and the other is from Babbage Cofounder, and showed Rand up 60–40. One of these polls is a GOP internal, the other utilizes an internet approach which is somewhat innovative.
  • From a money perspective, Rand Paul currently has about triple the money Jim Gray has: as of the FEC filings from the end of June, Paul has $2.9MM and Gray has $1MM.
  • While Gray can certainly self-fund, Paul has received contributions from 2,500 contributors while Gray only has contributions from about 1,500. HOWEVER, 1,200 of Gray’s contributors are from KY, while only 500 of Paul’s contributors are from KY.


New Kentucky Project

  • What is it: Matt Jones and Adam Edelen, announced shortly after the November election where Republicans won big
  • Their whole thing seems to be that Kentucky Dems aren’t running on ideas, they’re running on not being their opponent
  • Mission: Seeking to move Kentucky forward and modernize our state. Wants to embrace differences in opinion, rather than rigidly accept the two party dichotomy
  • Core values: equal protection, standing up for the working class, education, improving economic opportunity in all 120 counties, affordable medical care, transparent politics
  • County coordinators and executive committee notables: Clay Ford, Vanessa Cantley, James Kay, Angela Evans, Morgan McGarvey, Danny Alvarez, Craig Greenburg (21C)
  • What it’s not: A third political party, A Big D organization
  • 527=political organization
  • Organized as a 501©(3), tax exempt nonprofit, which cannot endorse or contribute to campaigns
  • What they can do: encourage participation, sponsor appearances, work to get their positions on a party’s platform
  • What they can’t do: publish materials in support of, supporting or criticizing a candidate on website, any endorsement
  • Facts and circumstances
  • Key differences: contributions are tax deductible and unlimited for 501©(3), disclosure requirements, 527s can’t do direct lobbying
  • “Not the Adam and Matt show”
  • Organizing people to run, focusing on rural counties
  • What says the KDP: Not much. When group first announced, Sannie said “KDP welcomes new ideas and new energy and we look forward to working with Matt and Adam to build our Party,” though subtly mentioning that their top priority at the time was winning the four upcoming special elections and maintaining control of the state House.”
  • More recently, KDP spokesman Daniel Lowry said, “We are 100 percent behind the mission of the New Kentucky Project and hope their efforts bring more excitement to important issues such as healthcare, education and job growth.”
  • Concerns: reduction in contributions, losing house majority