Kentucky Governor Seeks to Expand KCHIP Enrollment

Published November 1, 2008

Kentucky Gov. Steve Beshear (D) has implemented sweeping changes to the way marketing and enrollment are conducted for the Kentucky Children’s Health Program (KCHIP).

The changes were spurred by a report issued by Kentucky Voices for Health (KVH), which found 60,000 of the state’s children are eligible for taxpayer-funded health care coverage but aren’t enrolled.

KVH, which describes itself as a “coalition dedicated to expanding health coverage for uninsured Kentuckians,” says the state has done little to address the subsidized insurance enrollment shortfall.

Some policy experts have a different explanation, saying poorly managed, overly bureaucratic government programs are unattractive to many parents whose children are eligible.

Onerous Application Process

Before Beshear’s changes, parents were required to apply in person for KCHIP at a state social service office, which the KVH report says prevents some children from being insured, since parents might be unable to leave work or wait long periods of time in line. The report suggested parents should be able to apply at schools, hospitals, and clinics.

Beginning November 1, Kentucky parents will be able to download an enrollment form from the state government’s Web site and mail it in. In addition, the face-to-face interview process will be eliminated.

The new changes also require the state to call applicants if their application is missing information. Those whose applications are denied will be given a 30-day grace period to provide more information.

“The steps we are taking today to get more eligible children enrolled in the Kentucky Children’s Health Insurance Program are fiscally responsible, economically smart, and, quite simply, the right thing to do,” Beshear said at a press conference announcing the program.

Questionable Motives, Results

“Undoubtedly some children need assistance,” said Devon Herrick, Ph.D., a senior fellow with the National Center for Policy Analysis. “However, as eligibility rises, so does the risk of crowding out private coverage.

“For instance, 77 percent of children in households earning between 200 percent and 300 percent of the federal poverty level already have private coverage,” Herrick continued. “For children in families earning between 300 percent and 400 percent, 89 percent already have private coverage. It is conceivable to expand eligibility and boost public coverage without actually decreasing the ranks of uninsured children.”

“With this ‘report,’ KVH is simply remaining true to their big-government, anti-taxpayer leanings,” said Jeff Emanuel, research fellow for health care policy at The Heartland Institute and managing editor of Health Care News.

“But what do you expect from an organization whose first-ever policy paper, released earlier this year, was a contradictory call for both discouraging smoking and funding state health and human services programs by drastically increasing state tobacco taxes?” Emanuel asked.

Costly but Ineffective

The alterations in the process are expected to cost Kentucky taxpayers $31.1 million, and will also cost $81.3 million in federal taxpayer dollars, over the next two years.

The changes will affect only parents who are both eligible for enrollment and want the state’s help in providing insurance for their children—which is not necessarily a given, said John R. Graham, director of health care studies at the Pacific Research Institute.

“Families do not enroll their kids in government health plans for several reasons—not just because they don’t know about the benefit or because it’s too difficult to do so,” Graham said.

“It’s sometimes difficult for proponents of big-government solutions to all of life’s problems to comprehend, but quite often a significant portion of the population simply does not want what the government is offering,” added Emanuel.

Budgeting Concerns

According to the state department of health and human services, 93,000 Kentucky children are uninsured.

“A major problem is the inability of the state budget to cover the needs of the Medicaid program. Like any consumer, the state needs to stop paying for largely preventable bad outcomes and adopt Medicare rules regarding ‘never events,'” said Somerset resident Dr. Kevin Kavanaugh, chairman of Health Watch USA, a Kentucky-based organization that advocates for value-driven health care, competition, and health care transparency.

KCHIP is among the cheapest state Medicaid programs for residents, with most of the cost being picked up by taxpayers across the nation, but the state is still responsible for paying $100 million annually to maintain the program.

Kentucky journalist and market advocate Scott Edwards says the state’s health care struggles illustrate problems with the national Medicaid system.

“Government mandates have made insurance too expensive for many struggling families throughout the country,” Edwards said. “While Kentucky has tried some noble health care reforms in the last few years, bureaucracy is bureaucracy. If one state can’t deliver for poor children, do we really want the federal government running health care for everyone?”

Krystle Russin ([email protected]) writes from Texas.

For more information …

“Better Health Coverage for Children: Small Changes Mean Big Improvement,” Kentucky Voices for Health, August 18, 2008: