Banahan and Kentucky: Obamacare Done Right

LaTonya Ellington, 45, has Graves’ disease, a chronic condition that affects her thyroid and her vision. “I have a lot of problems with my eyes. I can’t lose weight because my metabolism is messed up,” she told me. Graves’ can lead to serious complications, even death, if untreated, but with treatment, it is quite easy to manage.

Ellington has had no medical insurance for the past 17 years. Two months ago when she was at the Family Health Center in Louisville, she saw a poster for kynect (Kentucky’s implementation of Obamacare), and decided “to sign up and see what’s going to happen.” Since, by Ellington’s own admission, she is “not computer-savvy,” she filled out the application at the clinic.

“When I applied for the insurance, that was the best eight minutes of my life,” Ellington told me. “It only took eight minutes to sign up, and it changed my life.” She photographed her application and displays it on her cell phone.

Now, with insurance and Medicaid, Ellington can see a specialist. She no longer pays for her daily medications or has to worry about the medical bills that pile up from her frequent doctor visits. “Peace of mind is everything,” she said.

This spring, Kentucky is in the limelight. The Kentucky Derby, always on the first Saturday in May, is drawing racing fans from all over the U.S. and beyond. Equally important, Kentucky also distinguishes itself for its success in implementing the Affordable Care Act (ACA), more popularly known as Obamacare. With its smoothly functioning website, Kentucky has enrolled more people per capita than any other state.

Kentucky is an anomaly among the red states. It is the only Southern state to both expand Medicaid and establish a state-based exchange under the provisions of the ACA.

What’s a State-Based Exchange?

These exchanges are state-specific online marketplaces where individuals and small businesses can shop for federally regulated, subsidized health insurance.

In states where elected officials have refused to establish a state-based exchange, residents have no option but to enroll in the federally run insurance marketplace—the one that had that disastrous rollout.

In Kentucky, the Republican legislature did not implement the ACA, so Democratic Gov. Steve Beshear filed an executive order to create the state exchange and expand Medicaid. The ACA provides for extending Medicaid eligibility to people whose income is up to 138 percent of the Federal Poverty Level. (The FPL for a family of four is $23,850.)

What’s the Virtue of a State-Based Exchange?

Health insurance marketplaces, both state and federal, provide government-regulated and standardized health care plans from which individuals may purchase health insurance policies eligible for federal subsidies.

State-based exchanges are able to tailor publicity and consumer assistance to the needs of their own residents. They make more people aware of the availability of health insurance, unlike states with federally run exchanges

Kynect Signups So Far:

When enrollment began on October first, 640,000 Kentuckians were uninsured, and 622,000 were uninsured and eligible for coverage under the ACA.

As of noon on April 21:

·         413,410 Kentuckians are enrolled in new health coverage

·         330,615 have qualified for Medicaid coverage (about 80 percent)

·         75 percent of the newly insured were previously uninsured

·        82,795 have purchased private insurance 

·         52 percent of all kynect enrollees are under age 35

·        Of those who purchased private insurance plans, 72 percen qualified for some level of premium coverage.

Carrie Banahan, 54, exudes energy and confidence. She was executive director of Kentucky’s Office of Health Policy when she was asked if she knew anyone who would be interested in the job of executive director of the eventual ACA program in Kentucky. Without hesitation, she replied, “I AM!”

Gov. Beshear knew that Banahan had more than 30 years’ experience in state government, and he appointed her to oversee and shape the entire project.

Banahan deserves a good deal of the credit for its success, but she insists on sharing credit with all the stakeholders. They were, she says, “tremendously supportive.” The Kentucky Chamber of Commerce, hospital and medical associations, insurance companies and agents—all wanted a state-based insurance marketplace, and Banahan brought them together for extensive planning sessions. She valued their input, soliciting their opinions and their expertise. As a result, kynect hasn’t been challenged on anything that it has done.

PhoneBankAsk me another: Banahan (center) taking insurance applicants’ calls at an AARP call center.

We spoke with Banahan in March, and we were joined by Gwenda Bond, Assistant Communications Director for the Cabinet for Health and Family Services.

The following conversation has been edited for brevity and clarity.

WVFC: Have you encountered political opposition among the public for what is now commonly called Obamacare? Your own Senator Mitch McConnell, the Minority Leader of the Senate, has said repeatedly that “This was the worst piece of legislation that has been passed in modern times. My goal . . .  is [to] repeal the entire thing . . .  [with] all the damage that this has created in our country to both the providers of healthcare and consumers of healthcare.”

C.B.: Some of our congressional delegation are not fans. I do think the buzzword “Obamacare” [is offputting to those who don’t like Obama]. A lot of people are not necessarily correlating [kynect] with the Affordable Care Act— but when you talk to them about the provisions in kynect, they’re very receptive to it.”

WVFC: Other than political opposition, what obstacles did you have to overcome?

C.B.: The aggressive timeline was our biggest challenge. We had been planning for a state-based exchange since September 2010. We started meeting at least weekly in October 2010 with Medicaid, insurance, and IT folks.

WVFC: Why did you decide, unlike the feds, to farm out the IT?

C.B.: We have great IT staff, but it was too big of a job for us to do in such a short period of time. We chose Deloitte through a procurement process and signed our first contract with them in early October 2012.

WVFC: How did you monitor their choices and progress?

C.B.: I have a good team. Our IT folks really cracked the whip and made sure the things were completed when they were supposed to be completed.

WVFC: To what do you attribute your success?

C.B.: [After three years of intensive planning], our website is simple and user-friendly, not a lot of bells and whistles. Everybody’s really committed and believes we need to insure as many people as possible. Everybody here works very hard and is very dedicated. I haven’t had anybody quit, despite long hours and weekends.

WVFC: When did you begin to test the system?

C.B. We tested for three months, from July to September 2013.

We were up and running on October 1 of 2013. The first day we didn’t have enough server capacity, because within hours we had thousands of people. We had no idea that we’d have the overwhelming response that we’ve had. At 9:30 there were system issues. People couldn’t apply for coverage. But the system never went down [for a whole day]. We came back up at 3 o’clock that afternoon and really haven’t had any issues since then.

WVFC: Are you having the “back-end” problems that some states have had, like having patients find that the insurance companies don’t have their information when they go to use the system?

C.B.: Sometimes they have to wait one or two weeks to receive their enrollment packets, but we really haven’t had any issues.

WVFC: Is there any interest in Kentucky in establishing nonprofit insurance organizations?

G.B.: We have one, the Kentucky Health Co-operative. As of now, it has about 75 percent of the private health market through the exchange.

WVFC: Do you have meetings with your opposite numbers in other states?

C.B.: Yes, we do. We have meetings and conference calls. We all learn from each other. We share concerns about issues we’re experiencing. It’s been beneficial, provided a lot of insight and valuable exchange of information.

WVFC: Any of those states in the South?

None of those states, unfortunately. I wish they would. I’m ready to go down and testify if they need me to in some of these Southern states and talk about our success, because I’ll tell you what: if we can do it here in Kentucky, they can do it in those other Southern states too.

WVFC: I guess you don’t have any close friends in those states—

C.B.: I really don’t! I’ve been interviewed on a radio show in Atlanta, which was fun. And the Atlanta Journal has come down and talked to us. I think in Georgia in particular there is interest in the Medicaid expansion as well as running their own state-based exchange. There’s interest from stakeholders; but in the political realm there’s not any interest in Kentucky coming down there and providing assistance or advice. But I’m willing to go!

WVFC: Is anything being done about the shortage of doctors in Kentucky’s rural areas?

C.B.: We try to keep Kentucky med school grads here, including foreign-born doctors. We commissioned a workforce study in areas where there was a need for additional providers.

G.B.: We had some shortages, but for the most part, not so bad as we had feared. We have a big shortage of behavioral health providers. The recommendation was to open up the network of providers. Traditionally, Medicaid reimbursed a very limited network of providers. Now, social workers, psychologists, marriage and family therapists provide services. The legislature just passed a bill allowing registered nurse practitioners to do more than previously.

WVFC: How has kynect made a difference to Kentuckians?

C.B.: Most of the folks we enrolled couldn’t afford health insurance. There’s a lot of pent-up demand out there because of individuals who just weren’t able to afford health care coverage. And now for the first time, through the Medicaid expansion, they’re going to be able to have a medical home, a primary care physician. They’re going to be able to have their chronic conditions or illnesses treated. In rural Kentucky— it’s kind of heart-wrenching. They can finally get their MRI for their back pain, they can finally get their knee surgery, they finally have enough money to afford their diabetes medication.

WVFC: What do you want to do next?

C.B. “I want to stay here for at least several years. There’s some improvements that we need to make. Our Small Business Help Option Program (SHOP) [for businesses with 50 or fewer employees]—our enrollment numbers are low. Before I leave, I want to make sure that we make drastic changes to SHOP to make our system more flexible and user-friendly for employers and agents, because right now it’s not.

I worked my way up through the ranks. I’ve heard so many hard-luck stories and had to tell so many people, “I’m sorry. You don’t qualify for Medicaid.” To see this come to fruition, it’s what I’ve been working for all of my life. This is the pinnacle of my career.

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  • Leigh April 22, 2014 at 11:02 am

    Wonderful to see healthcare successes in KY. I hope Senator McConnell loses his seat for relentlessly obstructing healthcare reform and pushing the hardworking people of Kentucky down. He is loyal to his ideology,not the people of Kentucky who elect him. I am hoping that the Lundegren-Grimes wins in November…

  • hillsmom April 22, 2014 at 10:07 am

    How nice to see something exciting in KY health care. What a woman! Dare I say that Mitch McConnell is probably less than pleased?