Princess Health and Kynectors, health advocates ask state to maintain staffing and other resources in new health-insurance enrollment system. Princessiccia

Princess Health and Kynectors, health advocates ask state to maintain staffing and other resources in new health-insurance enrollment system. Princessiccia

health insurance Kynect Medicaid obamacare state government

Gusty 16:00 Add Comment

As the administration of Gov. Matt Bevin works toward dismantling Kynect, the state's health insurance exchange, health advocates say they worry that the transition is going too quickly to be smooth, risking a loss of coverage for some Kentuckians.

Kentucky Voices for Health, a coalition of groups supporting health-care reform, said June 9 that the administration needs to "keep, hire and train adequate staff," make eligibility decisions quickly, "dedicate enough resources to educate the public on how to enroll," publish its plan and allow time for comment, and "create an online dashboard to measure how well the system is functioning."

The group also wants the administration to extend the transition period, saying that no state has made such a transition so quickly.

�To be successful, we need to take our time and make absolutely sure we�re protecting consumers from gaps in coverage," KVH Executive Director Emily Beauregard said. "By . . . taking more time to complete the transition, Kentucky can keep more of its people covered with access to essential care."

Whitney Allen, coordinator of community development and outreach for the Kentucky Primary Care Association, said in the KVH news release, �These recommendations are key to fostering a culture of continuous improvement focused on the consumer experience.�

Keeping a campaign promise, Bevin decided to shift Kentuckians enrolling in private, federally subsidized health insurance via Kynect to the federal exchange, www.healthcare.gov, and Medicaid recipients to Benefind, the state's new one-stop website for state benefits, by Nov. 1.

This new model for subsidized insurance is a federally supported but state-based marketplace, in which the federal government will handle consumers' eligibility appeals but the state will handle insurance-company grievances and still review insurance plans. The federal government will certify the plans but it will "strongly rely" on state recommendations, Health Secretary Vickie Glisson said in March. Consumer grievances will be handled by a state-federal partnership.

Kentucky Voices for Health said it wants "to ensure that any enrollment system that will replace Kynect works as well or better to ensure all Kentuckians have access to coverage without interruption or barriers."

Bevin's office replied to the KVH release with this statement: "Throughout the process, we have updated stakeholders and listened to their feedback. We appreciate the continued interest, input and cooperation of advocates as they are an important component of our communications and outreach strategy during the transition from Kynect to healthcare.gov. We are pleased to report that Kentucky has met all milestones and deliverables, some ahead of schedule, that were established by the [federal] team in order to proceed with the transition to healthcare.gov."

KVH continued to emphasize the importance of Kynectors, a blanket term used for those who help Kentuckians apply for and enroll in coverage. The state has about 600 Kynectors, but their fate is uncertain.

�Research indicates that Kentucky consumers find insurance overwhelming and confusing, and value the face-to-face assistance they have received to navigate the system,� Dr. Susan Buchino of the Commonwealth Institute of Kentucky, said in the KVH release. The institute, part of the University of Louisville School of Public Health and Information Sciences, calls itself a "transdisciplinary collaborative for population health improvement, policy and analytics."

KVH said the Bevin administration recently agreed to its request to have a diverse, multi-stakeholder advisory committee like the one that helped create Kynect.

The group said its recommendations came from Kynectors and health advocates, "many of whom have hands-on experience with enrollment and consumer assistance." Click here for the full report.

Forbes magazine contributor Josh Archambault wrote June 7 that Bevin is right to end Kynect because it serves mainly as a funnel to the Medicaid program and is funded by a fee on all health-insurance policies sold in Kentucky.

At least part of the fee will remain in place to help pay transition costs, fund the Kentucky Health Information Exchange and cover remaining claims to the high-risk insurance pool for which the fee was originally established. It was transformed into Kynect funding by an executive order from then-Gov. Steve Beshear.

"Kynect�s website will actually be active until the end of 2017, as the site also services small-business plans which have no set open-enrollment season," Archambault notes.

Princess Health and Study shows uninsured rate keeps falling, preventive services are popular and rural hospitals have more uncompensated care. Princessiccia

Princess Health and Study shows uninsured rate keeps falling, preventive services are popular and rural hospitals have more uncompensated care. Princessiccia

Foundation for a Healthy Kentucky health care access health insurance insurance coverage Kynect Medicaid prevention research

Gusty 13:54 Add Comment

By Melissa Patrick
Kentucky Health News

The share of Kentuckians without health insurance continues to drop, and new Medicaid enrollees continue to take advantage of free preventive health services, according to an ongoing study of federal health reform's impact in the state.

The Foundation for a Health Kentucky is paying the State Health Access Data Assistance Center at the University of Minnesota more than $280,000 for a three-year study of how the Patient Protection and Affordable Care Act is affecting Kentuckians.

The report found that the rate of people without health insurance in Kentucky continues to drop.

In December 2015, the uninsured rate was 7.5 percent, down from 9 percent in June 2015. The national rate in December was 11.7 percent. In 2013, before the implementation of the PPACA, Kentucky's uninsured rate was 20.4 percent.

Since December 2013, Kentucky's uninsured rate has dropped 12.9 percentage points, more than double the national decline of 5.6 percentage points, says the report. Uninsurance rates can vary depending on how they are measured. This study used data from the Gallup-Healthways Well-Being Index, which produces state-level estimates of coverage twice a year.

"Lack of insurance is a significant barrier to getting necessary health care and preventive services timely," Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, said in a news release. "Tracking this and other key information about access to and cost of care in Kentucky helps to inform health policy decisions."

Kentucky also continues to have a lower uninsured rate than its eight nearest surrounding states, although Ohio (7.6 percent) and West Virginia (7.7 percent) are catching up. Missouri (11.6 percent), Tennessee (13 percent) and Virginia (12.6 percent), the three states surrounding Kentucky that did not expand Medicaid, have the highest uninsured rates. (SHADAC map)

And while the state saw a smaller share of new health-insurance customers than the country overall (20 percent versus 39 percent), Kentucky had the largest percentage of re-enrollees (59 percent) return to Kynect, the state's health insurance marketplace, to select plans compared to the rest of the nation (36 percent). Twenty-two percent of Kentuckians were automatically re-enrolled in plans.

Kynect, created by the Democratic administration of Steve Beshear, is in the process of being dismantled by the administration of Republican Gov. Matt Bevin, so Kentuckians will have to sign up for their health insurance through the federal exchange, healthcare.gov, during the next enrollment period which begins Nov. 1, 2016 and runs through Jan. 31, 2017.

Traditional Medicaid enrollees will sign up through Benefind, the state's new one-stop-shop website that can be used to apply for Medicaid, the Kentucky Children's Health Insurance Program (KCHIP), the Supplemental Nutrition Assistance Program (SNAP, once known as food stamps) and Kentucky Transitional Assistance Program (KTAP).

Expansion of Medicaid added about 400,000 Kentuckians to the program, and many of them have taken advantage of its free services to get screened for diseases and have physical or dental examinations.

Dark blue: traditional Medicaid enrollees
Light blue: Medicaid expansion enrollees

The latest report, which covers the fourth quarter of 2015, says 823 traditional Medicaid enrollees got screened for diabetes, compared to 2,959 Medicaid expansion enrollees. This was also true for colorectal screenings (see graph).

Overall, the study found that Medicaid covered 41,493 dental preventive services, 9,708 breast cancer screenings, 8,276 substance-abuse treatment services, and 5,589 colorectal-cancer screenings to enrollees aged 19-64.

Under federal health reform, Beshear expanded Medicaid to include those with incomes up to 138 percent of the federal poverty level. The federal government pays for this expanded population through this year, but next year the state will be responsible for 5 percent of the expansion, rising in annual steps to the reform law's limit of 10 percent in 2020.

However, the future of the expansion is uncertain. Bevin has said that the state cannot afford its Medicaid population of about 1.3 million, and has charged his administration with designing a new Medicaid program, which will require federal government approval. He told reporters in early May that he was optimistic that the Centers for Medicare and Medicaid Services will approve the state's new plan, but if they don't it will be because "CMS does not want to see expanded Medicaid continue in Kentucky."

The study found that Medicaid enrollment continues to be the highest in Eastern Kentucky with 31 percent participation, followed by Western Kentucky at 26 percent participation.

It also notes that while levels of uncompensated care have dropped for both urban and rural hospitals since 2013, rural hospitals saw slight increases in uncompensated care in 2015. (SHADAC graphic)

For the full report, click here.

Princess Health and UnitedHealth will leave Ky. next year, leaving much of the state with only one or two choices for health insurance on exchange. Princessiccia

Princess Health and UnitedHealth will leave Ky. next year, leaving much of the state with only one or two choices for health insurance on exchange. Princessiccia

health insurance health reform Kynect obamacare Patient Protection and Affordable Care Act

Gusty 16:44 Add Comment

UnitedHealth Group Inc. won't be participating in Kentucky's individual insurance plans offered through the Affordable Care Act marketplace next year, which could leave about 20 percent of the state with just one insurer to choose from for next year and another 22 percent with only two choices, according to an analysis by the Kaiser Family Foundation.

Including Kentucky, this brings the number of states the health insurer is quitting next year to 26, Zachary Tracer reports for Bloomberg.

"The company plans to halt sales of individual plans in Kentucky for 2017, both inside and outside the state�s Affordable Care Act exchange, as well as the small-business exchange," United said in a letter dated March 28 to the state�s insurance department, Tracer reports. Bloomberg noted that it obtained the letter through an open-records request.

United warned in November that this would likely happen after reporting that "low enrollment and high usage cost the company millions of dollars," USA Today reported.

�UnitedHealthcare�s intent to withdraw from the market was not unexpected,� Doug Hogan, a spokesman for the state Public Protection Cabinet, which oversees the state�s insurance regulator, said in an e-mail to Bloomberg. �Insurers across the country have been losing hundreds of millions of dollars in the Obamacare exchanges and can no longer sustain such heavy financial losses.�

The administration of Republican Gov. Matt Bevin is shutting down the state's Kynect exchange and moving its 100,000 or so users to the federal exchange, but plans on that exchange are offered state by state.

Bloomberg says it has confirmed that United is leaving at least 26 of the 34 states where it sold 2016 coverage, but will continue to offer small-business plans off the exchange. New York and Nevada confirmed for Bloomberg that United plans to sell ACA plans in those states next year. The company has also filed plans to participate in Virginia.

Princess Health and Feds find security flaws in Kynect; state says no data breaches; problems also found in federal exchange. Princessiccia

Princess Health and Feds find security flaws in Kynect; state says no data breaches; problems also found in federal exchange. Princessiccia

electronic health records health insurance insurance exchange Kynect privacy

Gusty 14:41 Add Comment

State health-insurance exchanges in Kentucky, Vermont and California had "significant weaknesses" in protecting their electronic information from hackers, the Government Accountability Office said in a report last month.

"These included insufficient encryption and inadequately configured firewalls, among others," said the report from the investigating arm of Congress. "In September 2015, GAO reported these results to the three states, which generally agreed and have plans in place to address the weaknesses."

Ricardo Alonso-Zaldivar and Frankfort-based Adam Beam of The Associated Press report, "Vermont authorities would not discuss the findings, but officials in California and Kentucky said this week that there was no evidence hackers succeeded in stealing anything."

The report said the federal Centers for Medicare and Medicaid Services, which oversees the exchanges, had not fully implemented its oversight of their security and privacy protections.

"The GAO report examined the three states' systems from October 2013 to March 2015 and released an abbreviated, public version of its findings last month without identifying the states," AP reports. "Thursday, the GAO revealed the states' names in response to a Freedom of Information [Act] request from the AP. According to the GAO, one state did not encrypt passwords, potentially making it easy for hackers to gain access to individual accounts. One state did not properly use a filter to block hostile attempts to visit the website. And one state did not use the proper encryption on its servers, making it easier for hackers to get in. The report did not say which state had what problem."

Steve Beshear, who was governor until early December, told AP through a spokeswoman that "because of the time required to fix the technical issues, not all those issues had been addressed" when Republican Gov. Matt Bevin took over. "It is important to note that there were never any security breaches of any kind, and no one's information was ever compromised."

Doug Hogan, spokesman for the Cabinet for Health and Family Services, told AP the fixes "are in various stages of completion and implementation" and security is "of the utmost importance" to the Bevin administration.

Bevin is dismantling Kentucky's exchange, which Beshear branded as Kynect, and planning to transfer the 93,000-plus people who used it to buy federally subsidized policies to the federal exchange, Healthcare.gov.

"But Kentuckians' information might not be any safer on the federal exchange," AP reports. "According to the GAO report, Healthcare.gov had 316 security incidents between October 2013 and March 2015. Such incidents can include unauthorized access, disclosure of data or violations of security practices. None resulted in lost or stolen data, but the GAO said technical weaknesses with the federal system 'will likely continue to jeopardize the confidentiality, integrity and availability of Healthcare.gov.'"

Princess Health and Bevin administration is working to fix Benefind's technical glitches; 51,000 Kynect clients blocked from working with Kynectors. Princessiccia

Princess Health and Bevin administration is working to fix Benefind's technical glitches; 51,000 Kynect clients blocked from working with Kynectors. Princessiccia

Cabinet for Health and Family Services food stamps health insurance KCHIP Kynect Medicaid

Gusty 07:47 Add Comment

Update: 4/8/16 This story has been updated with comments from the Cabinet for Health and Family Services. 

By Melissa Patrick
Kentucky Health News

On Feb. 29, Gov. Matt Bevin's administration launched a new one-stop-shopping website for state benefits that was designed to make life easier for the one-fourth of Kentuckians eligible to use it. Instead, it caused an unprecedented disruptions of services after thousands received erroneous letters notifying them they would no longer receive their benefits.

Deborah Yetter of The Courier-Journal has reported extensively on the problem, with stories of Kentuckians who have lost their benefits and found it nearly impossible to get help because of hours-long waits in the state benefits offices and a phone system that tells them to call back later.

The website, called Benefind, can be used to apply for Medicaid, the Kentucky Children's Health Insurance Program (KCHIP), the Supplemental Nutrition Assistance Program (SNAP, once known as food stamps) and Kentucky Transitional Assistance Program (KTAP).

The problem goes beyond those programs. The 500 paid Kynectors, who help Kentuckians use the Kynect health-insurance exchange, have not been able to help because federal regulations require participants who use multiple services to first go though the Department of Community Based Services, the state agency that manages Benefind. As of now, Kynectors can only help Kentuckians who have never received other state benefits.

Health advocates have called the launch of Benefind a "disaster." At a March 31 news conference, Bevin, along with health officials from the Cabinet for Health and Family Services and a Deloitte Consulting official, acknowledged the widespread problems and said they were working tirelessly to correct them.

�Our primary focus is to ensure that we deliver, as seamlessly as possible, as safely as possible, as expediently as possible all the benefits that folks expect and need from the Commonwealth of Kentucky," Bevin said.

State officials at the news conference said they had worked with federal officials to extend benefits through April, so that no one should be cut off from Medicaid or SNAP if they qualified for those benefits in March. The state has also stopped automatic letters generated by Benefind.

In addition, they have updated websites and changed the phone message to better explain what is going on; extended the re-certification time frame for SNAP benefits from six months to 12 months, allowing those cases to continue with a simple review instead of a client interview; hired an additional 185 people to help with the deluge of telephone calls and visits to the local state benefit offices; and Deloitte has assigned trainers to every county to help the DCBS staff.

Officials have encouraged the public to log on to the Benefind self-service portal at https://benefind.ky.gov/ to ease the burden on processing centers.

So, what happened?

Deloitte built Benefind under the administration of Gov. Steve Beshear at a cost of $101.5 million to replace an outdated eligibility system. Deborah Sills of Deloitte said at the news conference that they believed the system was ready to launch at the end of February, but "there were some issues that didn't present themselves until after the system went live."

However, Ryland Barton of Louisville's WFPL reported that on Feb. 25, a 27-page "Worker Portal Defect Workaround Guide" was distributed to DCBS staff showing that the administration knew there would be problems with the rollout.

But the cabinet says a guide like this is standard procedure.

"Deloitte says a guide like that is standard operating procedure when you�re dealing with a huge system rollout like this," Doug Hogan, spokesman for the cabinet said in an e-mail. "It�s a new system and (this was) a guide to help staff navigate the system better and help them work though issues they might encounter. Additionally, there were these same types of documents for the original rollout of Kynect."

Bevin's administration explained that the problem has been caused by an automatic review of cases where information from Kynect and the old eligibility system didn't match.

�Cases where information between the Kynect case and legacy case did not match (for example, household composition or income) are required to be managed by a state agent before they can be acted upon by agents or Kynectors,� Jessica Ditto, Bevin�s communications director, told WFPL in an e-mail. �This constraint has been placed to protect program and data integrity � plus, this is required by federal law.�

Ditto told Barton about 51,000 cases are under review, and noted that once the conflicting data has been reconciled, "the cases will become open for Kynectors and agents again, just as before.�

Sills told reporters that Benefind had not been altered in any way from its original 2014 design and affirmed Bevin's stance that the move to Benefind had nothing to do with his administrations decision to close Kynect and move to the federal exchange.

"None of these issues are caused by any changes the current administration has made to the system's purpose or design," Sills said.

However, Beshear said in a news release that Kynect and Benefind were meant to work together, not for Benefind to take over signing people up for Medicaid.

"The Benefind program was developed to complement Kynect, the state-run exchange," Beshear said in the release. "Although he attempts to blame the 'prior administration,' Governor Bevin�s administration mismanaged the launch of this new system, and in doing so, created a disastrous situation for thousands of families in Kentucky."

Bevin and Deloitte say the system was always designed to support Medicaid enrollees. "Benefind is Kynect, Kynect is Benefind," Bevin said at the news conference.

Not really, says Kentucky Voices for Health, a coalition of groups supporting Kynect,  "For people needing Medicaid coverage and other social benefits right now, there is no right door for access, let alone 'one door'," the group said in a press release Wednesday. "Kynect was built to provide access to health insurance and Medicaid enrollment; and Benefind was built to enhance Kynect with additional social services benefits. While they�re part of the same system, they provide different essential functions."

However, Hogan noted  in the e-mail that page 15 of a training document for Kynectors originally posted November 2015 "clearly shows that Benefind was intended to process all Medicaid plans, even Qualified Health Plans...it was truly designed to process all benefits."

Beshear and his advocacy group, Save Kentucky Healthcare, have also released a one-minute video entitled "If It Ain't Broke Don't Fix It" criticizing the Bevin administration's rollout of the system.

Princess Health and At top legislative Republican's invitation, Democrats embrace Obamacare, or at least Kynect and Beshear's Medicaid expansion. Princessiccia

Princess Health and At top legislative Republican's invitation, Democrats embrace Obamacare, or at least Kynect and Beshear's Medicaid expansion. Princessiccia

elections governor health insurance insurance exchange Kynect legislation Medicaid obamacare Patient Protection and Affordable Care Act politics

Gusty 16:01 Add Comment

By Melissa Patrick
Kentucky Health News

With a verve for Obamacare most had not publicly demonstrated, state House Democrats passed bills March 22 to preserve the Kynect health insurance exchange and the state's expansion of the federal-state Medicaid program.

The almost entirely party-line votes were a response to Republican Senate President Robert Stivers, who had challenged the House to act on the bills so the public will know where legislators stand on health reform.

The Senate is not expected to pass House Bills 5 and 6, but may use them as a device for debate of an issue on which Republicans seem to think they have had the upper hand. Democrats appear to think otherwise.

"This is a political issue, we all know that," House Speaker Greg Stumbo said. "The president of the Senate wanted to challenge us to talk about it, so I think we ought to talk about it because . . . Kynect is working."

(The debate begins four minutes into the following KET video. The continuation of the debate can be seen here.)

Kynect, where Kentuckians can sign up for Medicaid or buy federally subsidized health insurance, was established under executive order with federal grant money by then-Gov. Steve Beshear, a Democrat. It is paid for by a 1 percent assessment on all insurance policies sold in the state. The fee formerly funded a pool for high-risk insurance, which health reform made unnecessary.

Gov. Matt Bevin and other Republicans say Kynect is not necessary because the federal exchange, used by most states, does the same thing. "We will still be providing Kentuckians with access to care," said Rep. Addia Wuchner, R-Florence. "It will be as easy as going to a different website."

Democrats say using the federal exchange will leave Kentuckians without enough of the assistance needed by people who are unfamiliar with health insurance. More than 400,000 Kentuckians have used Kynect to sign up for Medicaid and about 100,000 have used it to get health insurance, many with the help of Kynect-paid "Kynectors."

Rep. Darryl Owens, D-Louisville, the bills' sponsor, said many people in Kentucky don't have access to the Internet and that many who do are not "tech savvy." He said that a decrease in the number of helpers, who are available to meet clients after hours and at convenient locations, will create additional barriers to access for many Kentuckians.

Rep. Kelly Flood, D-Lexington, told the House about one of her constituents who learned in the middle of a family medical crisis that they had been dropped from Medicaid. Flood said the woman told her she could not "reach that wonderful Kynector who used to tell me what was going on."

The Kynector later told her that "she had been swamped with others like her who wanted to know what was happening to the stability of their health care that they had just secured," Flood said. "It is so much more complicated than just going to a new website. I am wanting us to understand the people whose lives are on the line."

The state, completing a plan put in place by the Beshear administration, recently shifted Medicaid users of Kynect to a new system called Benefind that handles most public-assistance programs.

Emily Beauregard, executive director for Kentucky Voices for Health, told Greg Stotelmyer of Public News Service that the wait times on Benefind are two hours and 6,000 to 7,000 calls are going unanswered each day. Advocates have said that the average wait time on Kynect is two minutes.

Cabinet for Health and Family Services spokesman Doug Hogan told Stotlemyre that there had been "difficulties" with the transition and the cabinet is "working diligently with the contractor to correct problems and make the system perform as was intended."

The House voted on the bills separately but the main debate touched on both Kynect and Beshear's expansion of Medicaid to people with incomes up to 138 percent of the federal poverty level. The federal government is paying for the expansion until next year, when states will begin paying 5 percent, rising to the law's limit of 10 percent in 2020.

Bevin and other Republicans say that is not sustainable, and he is negotiating with federal officials to change Medicaid to save money and add more personal responsibility, such as premiums, co-payments and deductibles.

Rep. Joni Jenkins, D-Louisville, chair of the House Budget Subcommittee on Human Services, said most Kentuckians who get insurance through Kynect and expanded Medicaid work in low-income jobs and without the program cannot afford insurance.

"With all of this great news -- more people covered, profitable hospitals, more jobs, better health care and wellness -- I believe the evidence is overwhelming that Kentucky must keep Kynect and expanded Medicaid," Jenkins said.

At times the debate was more about federal health reform in general than about the specifics of Kynect or Medicaid expansion.

Rep. Jim Gooch, a Providence insurance agent who recently became a Republican, said many Kentuckians have been helped by Obamacare, others have been hurt. He said many can't afford their co-payments and deductibles, and he said President Obama lied when he said people could keep their old health plans and doctors if they wanted after the reform law passed in 2010.

Another insurance agent, Rep. Jeff Greer, D-Brandenburg, argued the other side. He said the Patient Protection and Affordable Care Act had brought many people their first affordable health insurance, especially those with pre-existing conditions, and relieved many farmers of the need to to work another job to get insurance.

"What I see is that we have something that is working, and I'm in a field where I see it work and yet we want to dismantle it and go to something that we're not sure is gong to work or not, Greer said. "I just don't get it."

House Minority Leader Jeff Hoover, R-Jamestown, said using the federal exchange "will not cause a single policy to be canceled or a single person to lose coverage." He said 36 other states now use the federal exchange "seamlessly."

Hoover and other Republicans said the debate was overdue, referring to Beshear's executive actions that the legislature was unable to block.

The Kynect bill passed 52-46, followed by a 54-44 vote for the Medicaid expansion, with Republican Reps. Jim DuPlessis of Elizabethtown and Jim Stewart of Flat Lick joining the Democrats. Reps. Gerald Watkins, D-Paducah, and David Floyd, R-Bardstown, did not vote on either bill.

All House seats are on the November ballot. House Democratic Caucus Chair and state party Chair Sannie Overly was asked how a vote for Obamacare might affect the election. "I think that House Bill 5 and 6 are simply a message to others that we stand by our commitment to providing access to healthcare to all Kentuckians," she said. "We've seen that our constituents support making sure that their friends and neighbors and relatives have access to health care."

To the same question, Rep. Robert Benvenuti, R-Lexington, said, "I think the voters have already thoughtfully evaluated that and cast a strong vote for Gov. Bevin, so I do think it will come up again in these November elections."

Princess Health and Republicans accuse Beshear of holding down failed co-op's premiums to make Obamacare look good; he denies the charge. Princessiccia

Princess Health and Republicans accuse Beshear of holding down failed co-op's premiums to make Obamacare look good; he denies the charge. Princessiccia

federal spending General Assembly governor health insurance health reform insurance Kynect legislature Medicaid obamacare Patient Protection and Affordable Care Act politics state government

Gusty 13:09 Add Comment

By Al Cross
Kentucky Health News

Did Kentucky's government-sponsored insurance company fail because then-Gov. Steve Beshear and federal officials kept its rates artificially low to make Beshear's embrace of federal health reform look better?

Sen. Ralph Alvarado

That's what Republican state Sen. Ralph Alvarado of Winchester, using documents provided by Gov. Matt Bevin's office, suggested or claimed March 14 in a Senate floor speech about the Kentucky Health Cooperative.

"It appears that rates for the co-op may have been purposely kept down for the sake of optics, to make the rollout of the ACA in Kentucky appear successful when it clearly was not," Alvarado said, citing "multiple meetings between the co-op, the governor's office and CMS," the federal Centers for Medicare and Medicaid Services, which oversees the state-based co-ops created under the reform law, in the fall of 2014.

"Somewhere along the way rates were kept down despite these actuarial recommendations," which said the money-losing cooperative should increase its rates 35 to 40 percent for the 2015 plan year, Alvarado said. The co-op's average increase, announced in late October 2014, was 15 percent. In November, CMS expanded the co-op's $47 million solvency loan to $125 million "to try to sustain this company," he said.

Beshear denied the charges through a spokeswoman, Hayley Prim. She said in an email, "Rates were set by the co-op, which was a privately run insurance plan. Like all other insurance plans, the rates must be certified by the Department of Insurance and actuarially sound. The state did not hold rates artificially lower to improve optics."

CMS officials encouraged co-ops "to price their plans low and grow as fast as they could," Adam Cancryn reported for SNL Financial in November 2015, in a long article that is widely regarded as the best written about the failure of the co-ops. Twelve of the 23 have closed or plan to.

The insurance co-op's offices are in eastern Jefferson County.

In December 2014, the Kentucky Health Cooperative reported a loss of $50 million, "with several hazardous financial conditions indicated," Alvarado said, but that year its chief executive officer, chief financial officer and member-services vice president got bonuses of $50,000, $40,000 and $40,000 on top of their salaries of $250,000, $179,000 and $131,000.

"This company had no money, was in deficit, and yet funds were being used clearly for bonuses," Alvarado said. Its CFO, Leonard Sherman, left the company in December 2014, according to a document filed by its liquidators.

Joe Smith of Frankfort, who was chair of the cooperative's now-dissolved board, said in an interview that the salaries and bonuses were "probably a little bit less" than typical in the insurance industry. He said bonuses were paid because the co-op enrolled many more customers than expected, but no bonuses were paid after the first year.

Smith blamed "the Republican Congress" for killing the co-op and those in many other states by limiting the "risk corridor" subsidies paid to insurance companies for covering sicker-than-average populations.

He acknowledged that the Obama administration largely abandoned the co-ops, making them "a sacrificial lamb," but he said they could not effectively compete with large insurance companies, mainly because the reform law prohibited them from advertising, as the big insurers wanted. The law created funding for the not-for-profit cooperatives as a way to provide competition with for-profit insurers and hold premiums down.

Janie Miller, who was Beshear's first health secretary, resigned as CEO of the Kentucky Health Cooperative in June 2015. That October, the co-op said it had largely eliminated its losses but would close because it was getting only a $9.7 million of a $77 million risk-corridor subsidy that it needed to stay afloat. It is now in liquidation, supervised by Franklin Circuit Court.

Alvarado said Miller and her successor, Glenn Jennings, refused to appear at a legislative budget subcommittee meeting in November. He said the Insurance Department "gave us very limited answers about what happened, [which] made me wonder if any wrongdoing was involved."

Alvarado said the legislature's Program Review and Investigations Committee should examine the co-op's finances and the Senate should issue a subpoena requiring Miller and Jennings to appear.

Then-Gov. Steve Beshear,
discussing health reform at the
Brookings Institution in D.C.

Prim, Beshear's spokeswoman, said, "While it is unfortunate the co-op did not succeed, an overwhelming majority of Kentuckians have a positive view of Kynect," the online exchange where Kentuckians can buy federally subsidized health-insurance policies. "It has succeeded by providing low-cost health insurance options and creating a competitive marketplace for private insurers that have kept rates low for everyone."

In his speech, Alvarado incorrectly referred to Kynect policies as Medicaid, the federal-state health plan for the poor and disabled. Beshear expanded Medicaid eligibility to Kentuckians in households with incomes up to 138 percent of the federal poverty level.

Alvarado declined to give Kentucky Health News the documents to which he referred in his speech, saying he got them from Bevin's office, which could be asked for them.

Bevin's office provided the liquidators' first report, filed Dec. 31; an actuarial report on small-group plans for 2016, submitted in July 2015; an actuarial report on individual plans for 2015, filed in August 2014; and a February 2015 letter from Miller responding to the Insurance Department's request for a "corrective action plan." None of the documents mention the meetings Alvarado said occurred among CMS, the co-op and the governor's office.

The August 2014 actuarial report said, "The financial viability of KHC is in question. . . . KHC's projections reflect very aggressive assumptions, albeit within a reasonable range, and may result in a very optimistic view of future experience."

The co-op's members used medical services more often than it expected. In the second quarter, there were 263 hospital patient days per 1,000 members, higher than the pricing assumption of 184 per 1,000 but a still a "significant decrease" from the first quarter, for which the report did not give a figure.

The co-op was also having trouble dealing with members and health-care providers. Its corrective plan filed in February 2015 addressed complaints about such things as slow payment standards, paid premiums not being posted to members' accounts, complaints from in-network providers about being processed as out-of-network, and long waits for customer service, with supervisors not being available.

The liquidators' report to the court estimated that the co-op still owes about $80 million in claims, and their financial analysis left unclear whether all those claims would be paid. The balance sheet in the liquidators' statement, dated June 30, said the co-op had $117 million in assets and $128 million in liabilities, and the liabilities included only $67.7 million in unpaid claims. However, the co-op's biggest federal loan, of $125 million, is "subordinate to policyholder obligations, claimant and beneficiary claims, operating expenses and state reserve and solvency requirements," the report said. CMS, the federal agency, has asked an independent actuary to provide its own estimate of unpaid claims.

Princess Health and Bills to preserve Kynect and Medicaid expansion head for votes in Democratic House despite a likely death in Republican Senate. Princessiccia

Princess Health and Bills to preserve Kynect and Medicaid expansion head for votes in Democratic House despite a likely death in Republican Senate. Princessiccia

elections General Assembly health insurance insurance insurance exchange Kynect legislation legislature Medicaid politics

Gusty 18:41 Add Comment

By Melissa Patrick
Kentucky Health News

Bills to continue the Kynect health-insurance exchange and the state's current expansion of the federal-state Medicaid program passed out of the House Health and Welfare Committee March 17, starting a series of legislative votes on health reform that once seemed unlikely.

House Speaker Greg Stumbo said he expects the bills to pass the Democratic-majority chamber, even though Republicans in the fall elections could cast votes as support for "Obamacare," the federal reforms under which then-Gov. Steve Beshear created Kynect and expanded Medicaid.

�There�s never really been a debate on this issue,� Stumbo said. �There�s not been a true letting of the facts, if you will.�

Six days earlier, Senate President Robert Stivers had more or less dared Stumbo to move the bills, whose sponsor had said he did not expect them to pass the Republican-controlled Senate, in order to "have a full, fair debate on the issue" and see where legislators stand on it.

House Bill 5 would require the state to keep operating Kynect, which Gov. Matt Bevin is starting to dismantle or transform. In his campaign, Bevin vowed to abolish the exchange, saying it did nothing that the federal exchange does not. Recently his administration announced that it would continue operating a state-based exchange but use the federal exchange for enrollments.

"They're being pushed into what everyone calls Obamacare, and they don't want that," Stumbo told reporters.

House Bill 6 would keep the current expansion of Medicaid to people with incomes up to 138 percent of the federal poverty level. Bevin is negotiating with federal officials to change the program, saying it will not be sustainable once the state has to start paying part of the cost.

Rep. Darryl Owens

The committee approved the bills along party lines. Their sponsor, Rep. Darryl Owens, D-Louisville, said he filed them because "It is important for people to understand that there are those of us in this legislature that want to continue expanded Medicaid, that want to continue Kynect."

The exchange is paid for by a 1 percent assessment on all insurance policies sold in the state. The fee formerly funded a pool for high-risk insurance, which reform made unecessary. Approximately 1.4 million Kentuckians use Kynect, all but about 100,000 of them on Medicaid.

Kynect was started with federal grants. Rep. Robert Benvenuti, R-Lexington, argued that the state must include that $273 million when considering its cost. "I think most people in this room, most people in Kentucky, pay federal taxes as well, so this whole notion that there is a great federal money tree in which we can go pick off of and build things is just not correct," he said.

Owens replied, "I'm not saying it's a money tree, I'm just saying it's a grant that the federal government gave the states if they wanted to develop their own system," Owens said. "And I think the thing we miss when we talk about that is we have a great system; we have the best system in the country."

Rep. Tim Moore, R-Elizabethtown, whittled the definition of Kynect down to a business that advertises and markets Medicaid and health insurance to Kentuckians, and asked, "How do you spend that kind of money to go out and build a marketplace for soliciting folks to do what would be in their own interest anyway?"

Cara Stewart of the Kentucky Equal Justice Center said the marketing has value because it has created a brand that Kentuckians recognize and trust, allowing them to know where to go to get health insurance. She said Kynect runs seamlessly to help Kentuckians shop and enroll in coverage for both Medicaid and federally subsidized insurance plans, unlike Bevin's approach.

She said later that it now takes two minutes to reach customer service on Kynect and two hours on Benefind, which is operated by the state Department of Community Based Services. "We are radically changing the quality of service to Kentuckians," she said.

Rep. Tim Moore

Moore said he was glad the bills would be voted on because Kynect and the Medicaid expansion had been created through "dictatorship," not "the will of the people." Beshear acted under a state law that requires the government to get as much federal money as possible for Medicaid, and he used his broad executive powers under the state constitution to transform the high-risk pool into Kynect.

Moore said Bevin's election showed public opinion on the issue. However, a poll in November, after the election, showed Kentuckians supported the Medicaid expansion by 3� to 1 and keeping Kynect by 2 to 1.

Democratic Rep. David Watkins, a retired physician from Henderson who voted for both bills, said, "It is kind of sad that our citizens don't pay attention to what our politicians are saying because they do have consequences."

Democratic Rep. Joni Jenkins of Louisville, chair of the House Budget Subcommittee on Human Services, said her panel's hearings convinced her that the state needs to keep it. She said there is value in having one system for Kentuckians to access health insurance, and to have Kynectors, who not only help people access health insurance, but also help them access health services.

Emily Beauregard, executive director for Kentucky Voices For Health, said after the meeting that navigating health insurance is difficult, especially for those who have never had it. "We need to help connect people to a source of care and help them understand how to use their benefits and that's what we've been able to do through Kynect," she said. "Coverage alone is not going to solve Kentucky's health issues."

Benvenuti said after the meeting, "There are various ways to get people to health care and creating a huge governmental system that is duplicative of the federal system is simply not the best use of our dollars."

As for Medicaid, Benvenuti said, "We've got to create a system where everybody who gets health care through an expansion population, or however you want to define it, has skin in the game and is responsible ultimately for their own health care."

Princess Health and Stivers calls for House bills on Kynect and Medicaid expansion, says Senate would vote on them to show where legislators stand. Princessiccia

Princess Health and Stivers calls for House bills on Kynect and Medicaid expansion, says Senate would vote on them to show where legislators stand. Princessiccia

health insurance Kynect legislation Medicaid obamacare Patient Protection and Affordable Health Care Act

Gusty 19:37 Add Comment

By Melissa Patrick
Kentucky Health News

Republican Senate President Robert Stivers challenged Democratic House Speaker Greg Stumbo Friday to send the Senate two House bills that would preserve the state's embrace of "Obamacare," in order to "have a full, fair debate on the issue" and see where legislators stand on it.

Robert Stivers

Stivers was referring to House Bill 5, which would require Kentucky to keep operating the Kynect health-insurance exchange, and House Bill 6, which would keep the state's current expansion of the federal-state Medicaid program.

Both would block Republican Gov. Matt Bevin's plans to change the programs, and with the Senate firmly in Republican control, their main sponsor, Rep. Darryl Owens, D-Louisville, has said he doesn't expect them to become law. Stivers noted that the bills aren't moving, despite being sponsored by several leaders of the House's Democratic majority.

�I would surmise that what they�re doing is just pandering and playing to a political base even though they don�t believe it�s good,� he said. �If they truly believe it's good, then vote them on the House floor.� Referring to House Speaker Greg Stumbo, he added, �If he votes it on the House floor, we'll vote 'em on the Senate floor.�

Stumbo said it was interesting that Stivers is attacking Obamacare when Bevin's plan for Kynect will use the federal health-insurance exchange, Don Weber reports for cn|2's "Pure Politics."

�He�s dismantling our Beshearcare here in Kentucky that Kentuckians were so happy to have. So, I'd be happy to have that discussion."

Former Gov. Steve Beshear, founder of non-profit Save Kentucky Healthcare, said in a press release that Stivers and Republican leaders are �once again touting misinformation about Kynect and the state of health care in Kentucky.�

Stivers claimed that the federal Bureau of Labor Statistics showed that the state had lost 3,500 health-care jobs while Beshear had promised that the expansion of Medicaid would add 5,400 such jobs in the state by bringing more people into the health care system, creating jobs and tax revenue.

Actually, BLS data show that while hospitals lost employment, overall employment in the health-care and social-assistance sector has gone up 4.6 percent since Obamacare was fully implemented in January 2014, compared to 3.1 percent job growth in all other Kentucky sectors, says Jason Bailey of the Kentucky Center for Economic Policy. (KCEP chart)

Beshear cited that data, adding, �Just last week Governor Bevin�s own administration released data showing that the educational and health services sector in Kentucky gained 4,200 jobs in 2015 alone.�

Princess Health and Low-income workers say to keep Kynect and Medicaid expansion; advocates wonder how new insurance exchange will work. Princessiccia

Princess Health and Low-income workers say to keep Kynect and Medicaid expansion; advocates wonder how new insurance exchange will work. Princessiccia

health insurance Kynect Medicaid Patient Protection and Affordable Care Act working poor

Gusty 20:46 Add Comment

By Melissa Patrick
Kentucky Health News

As Republican Gov. Matt Bevin's administration moves forward with plans to dismantle Kynect, the state's health insurance exchange, several working Kentuckians shared stories at a news conference March 8 about how having affordable health insurance through Kynect and expansion of Medicaid has changed their lives, and asked the governor to reconsider his decision.

Jesus Gonzalez and Troy May

"For working Kentuckians in particular, Kynect is much more than just a website. It is a one-stop-shop for coverage that allows workers, students and caregivers an easy and seamless way to not only enroll in coverage, but to move easily between Medicaid and private insurance as their incomes fluctuate," said Emily Beauregard, executive director of Kentucky Voices for Health, an umbrella group of health-care lobbying organizations.

Beauregard said that contrary to popular belief, most newly insured Kentuckians are low-income workers who didn't have health benefits.

One of the part-time workers from Covington, Troy May, who is also a full-time graduate student at Cincinnati Christian University, explained how getting insurance through a qualified health plan on Kynect has allowed him to pursue a new career, work part-time and also care for his 90-year-old grandmother. He said federally subsidized insurance from Kynect "fills in the gap" between his life now and when he will eventually work full time and get work benefits.

"Every time that Gov. Bevin talks about dismantling Kynect," May said, "it's like a punch in the stomach." He said the same coverage he gets on Kynect will be $200 more a month, with higher deductibles and co-payments on the federal exchange, which he says is not affordable.

"So this idea that we can easily move to a federal exchange and it not impact Kentuckians negatively is just flat out wrong," he said, adding later, "I beg Governor Bevin and the Republicans in the state not to dismantle Kynect."

May said he is a Democrat who comes from a family of Republicans, many of whom have signed up for health insurance through Kynect and have asked him, on their behalf, to ask Bevin to reverse his decision.

Another worker, Jesus Gonzalez, a single father and a food server in a Lexington restaurant, signed up on Kynect for the Medicaid expansion, which allows those with incomes up to 138 percent of the federal poverty line to enroll. He said that he had not had health insurance for the past 10 years because he couldn't afford it and shared stories about the "peace of mind" he now has because he can go to the doctor and the dentist. He said this has "made a huge difference in my life."

"It is really important that we do what we can to save and keep Kynect and Mediciad expansion in Kentucky," Gonzalez said. Bevin has said the expansion won't be sustainable once the state has to start paying a small part of the cost next year, and is negotiating changes in the program with the federal government.

The conference was sponsored by Keep Kentucky Covered, a coalition that is focused on sustaining access to affordable health coverage in Kentucky through Medicaid expansion and Kynect.

Pleas to save Kynect are likely falling on deaf ears. Bevin campaigned on closing Kynect, and has said it is redundant because there is a federal exchange that does the same things.

Advocates argue that Kynect provides one website to sign up for subsidized insurance and Medicaid, while Bevin's new model will require two websites, one called Benefind for Medicaid and other public-assistance programs, and the HealthCare.gov for federally subsidized insurance.

Health Secretary Vickie Yates Brown Glisson told a House budget subcommittee last week that the state would move to a "supported state-based marketplace" that will allow it to keep some control over review of insurance plans and handle insurance-company grievances, but the actual enrollment and any consumers' eligibility appeals will be handled by the federal exchange. Consumer grievances will be handled by a state-federal partnership.

Glisson said she didn't know how many Kynectors, or health-insurance navigators, will remain. Beauregard and Rep. Joni Jenkins, D-Louisville, chair of the House Budget Review Subcommittee on Human Services, voiced concerns about the abilities of local offices of the Department of Community Based Services to handle the 1.3 million Kentuckians on Medicaid.

"They are already overburdened and overwhelmed with the amount of work that they are doing and facing budget cuts," Beauregard said. "I worry that people are going to have a harder time getting enrolled in coverage and keeping their coverage, and getting the assistance they need when they run into an application problem or need to ask a question."

Wait times at DCBS offices average 2 hours and 44 minutes, while wait times at the Kynect call center are 2.15 minutes, according to the education and outreach director at Kynect, Beauregard said.

Jenkins voiced the same concerns in a separate interview, also noting the importance of Kynectors who not only help people sign up for health insurance, but also help them access health care after they sign up.

"I would hope that our state's goal was to not only get people signed up, but (to also) connect them with health care," Jenkins said. Later adding, "I find it so interesting that we are going to do away with a Kentucky-made product that is working so well, that pays for itself, and that was paid for by federal dollars and it's like letting big brother come down and -- so, that is very interesting,"

Glisson told the subcommittee that she believed there would be some funding for Kynectors. She also said the county-based employees of her cabinet could help people get to the federal exchange if they don't qualify for Medicaid.

But even if some Kynectors are included in this new model, the number of them will be determined by the number of people on the federally subsidized plans, and not include funding for Kynectors to help those on Medicaid, Beauregard said, "so you will also see a difference in the level of service you get if you enroll in Medicaid verses enrolling in a private plan," she said.

"What is really important right now is to ensure that we have an enrollment system that works as well or better than Kynect moving forward for all of the Medicaid recipients in Kentucky," Beauregard said. "And what that means is that we have to make sure that we have the capacity, whether that be at the Kynect call centers or in DCBS, to help these individuals enroll in coverage and to make sure that we are not creating barriers that translate into our uninsured rates going higher again or people loosing access to the care that they critically need,"

Princess Health and Citing costs, Bevin has said he would shut down Kynect; actually, insurance companies pay for it; Medicaid is another matter.Princessiccia

Princess Health and Citing costs, Bevin has said he would shut down Kynect; actually, insurance companies pay for it; Medicaid is another matter.Princessiccia

Affordable Care Act courts elections health insurance insurance coverage insurance exchange Kynect Medicaid politics

Gusty 06:46 Add Comment

By Molly Burchett and Al Cross
Kentucky Health News

The governor's race between Democrat Jack Conway and Republican Matt Bevin will spotlight the Patient Protection and Affordable Care Act, an issue that affects all Kentuckians at least indirectly.

Conway, in his eighth year as attorney general, says he would have voted for the law. Bevin, who was the most conservative candidate in his primary, has said he would shut down the state's health-insurance exchange, Kynect, that was established under the law, because it will cost the state hundreds of millions of dollars.

Actually, Kynect is paid for by insurance companies that sell policies in Kentucky. Bevin appears to be referring to the projected cost of expanding Medicaid, another Obamacare-related move that Democratic Gov. Steve Beshear made at the same time he created Kynect. It raised the program's income limit to 138 percent of the federal poverty level, from 69 percent.

The federal government is paying the entire cost of the Medicaid expansion for the first three years. In 2017, the state will pay 3 percent, gradually rising to the law's cap of 10 percent in 2020. A study for the state projects that the expansion will pay for itself until 2021 by expanding health-care jobs and generating economic activity and tax revenue.

Bevin has scoffed at those projections. Conway has said the state needs to provide health coverage, but only what it can afford.

As Kentuckians, voters, and consumers of health insurance, you may be asking: What's going on with Obamacare in the state? Are we able to afford it? Who and what should we believe? While the cost of Medicaid expansion is debatable, it's becoming clear that Kynect has avoided the problems plaguing other state-run exchanges.

So far, the Centers for Medicare and Medicaid Services has dispensed more than $4.9 billion in grants to help launch state-run exchanges. Kentucky received $253 million for the initial planning and development phases of Kynect. Now its $28 million annual cost is covered by a fee on insurance companies, state officials say.

Despite federal support and their own revenue sources, many of the 17 state-based exchanges are expecting deficits this year and in the future. Many will continue to rely on leftover federal funds to pay for operations this year, report Darius Tahir and Paul Demko of Modern Healthcare. Hawaii announced this week that it would close its exchange and transfer clients to the federal exchange because of continued funding problems.

Kynect officials say it isn't having such problems because the state has ensured that Kynect is self-supporting through fees on insurance plans.

"The governor committed that the exchange would be self-supporting and would not rely on state General Fund dollars," said Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services. "Kentucky�s sustainability plan employs an existing assessment on insurers that was previously used to fund Kentucky Access, the state�s high-risk pool, which was closed [since] individuals previously enrolled are now eligible to purchase a plan through Kynect."

But to transform Kentucky Access into Kynect, Beshear used executive orders that bypassed the General Assembly, where Republicans control the Senate. They have questioned his use of executive powers but generally have not been critical of Kynect.

The fee on insurers is a 1 percent, broad-based assessment on all policies sold by companies offering plans through the exchange. While insurers don't pass this fee directly to consumers, it almost certainly figures into their calculation of premium calculation and thus is indirectly paid by policyholders. The federal exchange is financed in a similar way, but its fee is 3.5 percent, meaning higher costs for insurers and policyholders.

In most cases, premiums for Kynect policies are reduced by a federal income-tax subsidy that is a key part of Obamacare.

"The vast majority of Kentuckians buying health insurance through Kynect are eligible for some kind of payment assistance or subsidy," Beshear said in commenting on most health-insurance companies recent requests for premium increases. "That cost will vary from family to family, so talking about rate changes in a vacuum isn�t a very effective way to gauge how much those rate fluctuations may affect policyholders or those shopping for insurance."

Bevin says he would move Kynect customers to the federal exchange, but the U.S. Supreme Court could rule this month that the tax subsidies are not supposed to be available through the federal exchange. The plaintiffs in the case cite a passage of the law that opponents say was a drafting error and does not make sense when the law is viewed as a whole.

If the court agrees with the plaintiffs, and Congress doesn't change the law, states using the federal exchanges will see spikes in insurance premiums, and millions of people could be at risk of losing their insurance. Bevin has not said what he would do in case of such a ruling.

Independent Drew Curtis is also running for governor.

Princess Health and Most insured through Kynect will pay more in 2016; Kentucky Health Cooperative seeks 25 percent increase.Princessiccia

Princess Health and Most insured through Kynect will pay more in 2016; Kentucky Health Cooperative seeks 25 percent increase.Princessiccia

Affordable Care Act health care reform health insurance insurance coverage insurance exchange Kynect Patient Protection and Affordable Care Act

Gusty 19:16 Add Comment

By Molly Burchett
Kentucky Health News

The federal health law requires that insurers planning to significantly increase premiums for policies on a health-insurance exchange to submit their rates by June 1 for review. Many insurance carriers across the country, including four in Kentucky, are requesting double-digit increases in insurance premiums for 2016.

For the individual market, the requested average rates from companies already participating in the Kynect exchange are:

• Anthem Health Plans, 14.6 percent increase;
• CareSource Kentucky, 11.8 percent increase;
• Humana Inc., 5.2 percent increase;
• Kentucky Health Cooperative, 25.1 percent increase;
• WellCare Health Plans, a 9.28 percent decrease.

The rates are not final, but are subject to approval by the state Department of Insurance, "so we don�t yet know what the final numbers will be," Gov. Steve Beshear said. "Changes still may occur. Rates should be finalized sometime in mid-July. We do expect that some plan rates will go down, some will go up and some will stay close to the same as last year."

Consumers will have more choices when enrollment opens, because the exchange is adding three new insurers to its individual market. United Healthcare will be offering coverage statewide, Aetna policies will be available in 10 counties, and Baptist Health Plan, now Bluegrass Family Health, will offer coverage in 79 counties. CareSource will expand its coverage area from 16 to 67 counties.

With these additions, at least three insurers will be offering Kynect coverage in every county, said Ronda Sloan of the Department of Insurance.

"When open enrollment begins this fall, Kentuckians should seek information about their individual plans, not average costs," Beshear said. "System-wide averages don�t give a good picture of what an individual�s out-of-pocket costs may be."

It is also important to keep in mind that premiums cannot be viewed in isolation, and you should look at the individual market dynamics that impact how much consumers pay for their health care coverage.

Why are most rates going up?

For an insurance company to survive, its cost of providing benefits should be less than the premiumums paid for those benefits. Companies now have had more than a full year of claims data to inform pricing structures, and many insurers are finding that people who buy policies on exchanges are considerably older and sicker than anticipated, reports Megan McArdle of Bloomberg News.

As a result, insurers are incurring greater costs of providing benefits than expected. Initially, the U.S. Department of Health and Human Services said that about 40 percent of the exchange policies should be bought by people between 18 and 35, the most healthy age group, to keep the exchanges financially stable. However, according to HHS data, that group accounted for only 28 percent of the policies in 2014 and 2015.

Not only do older people have more complex and more costly health needs, rising premiums in some state-based exchanges are due in part to the uncertainty in the overall health-insurance marketplace. First, there is much uncertainly about the reform law's "risk corridor program," which was designed to have insurers share the financial risk of offering policies on Obamacare exchanges from 2014 through 2016.

The program creates a pool of money to reduce risk for insurers: Those that pay out less in benefits than they collect in premiums pay into the pool; those whose premiums don't cover the cost of providing benefits take money from the pool. However, a recent Standard & Poor's report says the risk corridor will probably not get enough money from insurers with profitable exchange plans, so many insurers must raise premiums to support themselves.

Kentucky Health Cooperative needs shoring up

In another potentially worrisome sign, some insurers had risk-corridor receivables that exceeded half of their reported capital, and Kentucky Health Cooperative had the second-highest level of receivables as a percentage of capital: 117 percent, reports CNBC. That helps explain why it has asked for the largest average increase in premiums this year, 25 percent, and last year, 20 percent. The cooperative is one of several start-ups funded by the reform law to encourage competition in states; it sells most of the 106,000 private policies on Kynect.

Other reasons for the overall premium increases include rising health-care costs, especially for prescription drugs, Larry Levitt, senior vice president of the Kaiser Family Foundation, said on "PBS NewsHour" Wednesday night.

Speaking nationally, Levitt said state regulation means the requested premiums "will come down, in some cases by a lot." He said "Insurers are jockeying for position in these new marketplaces [so] there are some good deals to be had, but consumers really have to look around,"

David Blumenthal, president of The Commonwealth Fund, which researches health and social policy, said exchanges like Kynect "give people the ability to comparison-shop much more easily than before."

Princess Health and3,047 got private health insurance in special March-April signup designed to avoid or reduce tax penalty for not being covered.Princessiccia

Princess Health and3,047 got private health insurance in special March-April signup designed to avoid or reduce tax penalty for not being covered.Princessiccia

health insurance Kynect obamacare Patient Protection and Affordable Care Act

Gusty 08:52 Add Comment

More than 3,000 Kentuckians signed up for health coverage during a special March-April enrollment period that allowed them to avoid or reduce tax penalties for being uninsured.

"At the Feb. 15 close of the 2015 open enrollment period, 158,685 individuals had enrolled in health care coverage through Kynect for 2015," a state press release said. "That number included 102,830 Kentuckians who have either newly enrolled in a qualified health plan since Nov. 15, 2014, or renewed the private insurance plan they purchased through Kynect last year."

With the additional 3,047 enrollments, the final enrollment in private health insurance was 105,877. The federal tax penalty for being uninsured in 2014 was $95 for each adult household member or 1 percent of income, whichever is greater. In 2015, it will be $325 for each adult or two percent of income, whichever is greater. Penalties for not insuring children are half those for adults.

�Given that the personal risks of not having health coverage are even greater than the penalties, we decided to continue a special enrollment period to allow those individuals more time to sign up,� Gov. Steve Beshear said in the release.

Those who took advantage of the special enrollment period will still owe a penalty for any months they were uninsured and did not qualify for an exemption in 2014 and 2015. "This special enrollment period was designed to allow such individuals the opportunity to get covered for the remainder of the year and avoid additional fees for 2015," the release said.

Princess Health andKynect has an app for smartphones .Princessiccia

Princess Health andKynect has an app for smartphones .Princessiccia

health insurance Kynect technology

Gusty 09:49 Add Comment

Kentucky's state health benefits exchange, Kynect, is offering a free mobile app that will provide "on-the-go" access to the health-insurance marketplace.

The  smartphone app will allow you to log in to your account, browse plans, report changes in your circumstances, take photos of required verification documents and upload those photos directly to your account.

It can also help determine if you qualify for low-cost or free health coverage, get information about your coverage options, find out enrollment dates and learn how certain life events can qualify you to enroll now.

It allows you to log in to your Kentucky Online Gateway Account, look at the status of your health care plan or application, get more information about your current health care plan, access alerts, notifications or messages related to your account and view and update contact information.

And if you have further questions, it can connect you to an insurance agent or nearby "Kynector."

The app is available for download in the iTunes Store for Apple devices or in the Google Play Store for Android users.