Louisville Magazine

AUG 2016

Louisville Magazine is Louisville's city magazine, covering Louisville people, lifestyles, politics, sports, restaurants, entertainment and homes. Includes a monthly calendar of events.

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LOUISVILLE MAGAZINE 8.16 67 passed. According to the National Health Interview Survey (which the CDC con- ducts annually), the uninsured rate among nonelderly adults fell from 18.8 percent in 2013 to 6.8 percent in 2015. At the Portland Family Health Center, Ashley Shoemaker helps people sign up for health insurance. She has seen a lot of clients who don't have coverage through work, can't afford private insurance plans and didn't previously qualify for Medic- aid. "(Signing up) changes their whole outlook, because maybe they can go see a specialist that they've been putting off, or they can go to the dentist and they haven't been in years. So really, people leave excit- ed," Shoemaker says. But any excitement about signing up for Medicaid these days is probably tinged with nervousness. Since he started campaigning, Gov. Matt Bevin has been saying he wants to cut back the Medicaid expansion (among many other spending cuts). In June, he unveiled a plan called Kentucky HEALTH (an acronym of Helping to Engage and Achieve Long Term Health). It's his administration's an- swer to Section 1115 of the federal Social Security Act, which gives states the ability to design their own Medicaid programs, as long as the Secretary of Health and Human Services approves them. Sitting at a picnic table in Cherokee Park, Brandie Crawford picks up a copy of the proposal she has printed out and written comments on. She's particularly worried about the part that would require able-bodied adults to volunteer or work for up to 20 hours per week, or submit proof that they're looking for a job. It's not certain the requirement would apply to her yet, but she says it would be impossi- ble to meet because she takes her husband to physical and occupational therapy at Frazier Rehab five days a week and cares for him around the clock otherwise. e Crawfords, who live in Shelbyville, say the proposal strikes them as demean- ing and condescending. Part of it would require members who don't pay the proposed premiums to take a financial literacy course or be locked out for the next six months. "A financial course isn't going to help my situation or any other family's situation. We're all very much aware of our financial situation," Brandie says. "You can't financially manage something that you don't have a lot of." Brandie estimates their annual income is about $18,000, which includes Bob's disabil- ity payments and assistance from family. ey raised money to buy a wheelchair-accessible van. ere's also a section about managed-care reform that the Crawfords fear could apply to Bob. Basically, it says that the state would provide incentives for Medicaid plan providers to cut spending. So far, Bob's provider hasn't questioned any of his physical and occupational therapy because he keeps making progress on assessments, but he's seen it happen to other patients like him. "ey're deeming a lot of stuff Frazier does as exper- imental. And it's crazy," he says. "I see other patients coming there and doing this stuff and making improvements and they're just getting turned away." (Without insurance, the Crawfords would need to pay $2,500 a month out of pocket to cover Bob's physical therapy.) To consider the proposal, the federal government requires at least two hearings at which the public can comment, and a period for written comments on the plan. Emily Be- auregard, executive director of the health-ad- vocacy coalition Kentucky Voices for Health, has been at all three hearings, in Bowling Green, Frankfort and Hazard. (She says there's been criticism that the hearings weren't in Louisville and Lexington, which have the largest populations affected by expanded Medicaid.) She notes that a lot of people have had the same concerns as the Crawfords about the work and volunteer requirements and proposed premiums and co-pays. She says there's also outcry against eliminating vi- sion and dental coverage, the basic versions of which Medicaid is covering. If the proposed plan works out, people insured by Medicaid would have to take health classes or do com- munity engagement activities to get up to $500 a year to go toward "enhanced benefits" like vision, dental and gym memberships. ese changes to the Medicaid expansion will only happen if the U.S. Secretary of Health and Human Services approves them. ere won't be any word on that until at least September. But Bevin has said he'll get rid of expanded Medicaid completely if his plan isn't approved. Since Bevin's inauguration in December, there's been a lot of confusion among Kentuckians regarding health insurance. Anne Peak, who does community engagement for the Shaw- nee Christian Healthcare Center, said she was at an event in Chickasaw Park recently, handing out information about health insurance. "Several people came up to me and said, 'I thought Kynect was gone,'" she says. Technically, Kynect — the online platform used to sign up for Medicaid and other individual health insurance plans — still exists, but Peak says some people think Kynect and expanded Medicaid are the same thing. Shoemaker from the Portland Family Health Center and Jan Louden, who signs people up for insurance at Louisville Metro Corrections facilities, say they hear the same thing frequently. "ey've heard about the changes that are going to be put forth, that our governor really isn't a supporter of (expanded Medicaid), and they think (Kynect) is just gone," Louden says. Brandie Crawford says she'd love to return to work and get off Medicaid, but right now there are only three options: do what she's currently doing; go back to work and, because Bob would be covered under any insurance plan she'd get, risk losing the access to the care he's getting through Medicaid and other state assistance; or move Bob to a nurs- ing home. She gets tears in her eyes as she says, "I promised him that day in the ER that as long as there's air in me, he won't go to a nursing home. at's just not going to happen." Bob wants to get back in the work- force too, in some capacity. Right now, he treats his therapy like a full-time job. His goal is to keep making improve- ments at every six-week assessment so he can continue therapy. At this point, he can stand and take a few steps with the help of a walker and an assistant. He can also lightly pinch his left thumb and pointer finger together. It's a big improvement considering that right after the accident, people at the hospital told Brandie he'd have to be on a feeding tube for the rest of his life. "ere seems to be this tunnel vision of, 'Well, you're just a freeloader, and you need some skin in the game.' We've got a lot of skin in this game," Brandie says. "I feel like we give up a pound of flesh daily, because every day I'm battling something and every day he's battling and working as hard as he can." She gets tears in her eyes as she says, "I promised him that day in the ER that as long as there's air in me, he won't go to a nursing home."

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