- Associated Press - Thursday, November 13, 2014

LEXINGTON, Ky. (AP) - Holiday shoppers at Fayette Mall can now buy some health insurance to go with their Jamba Juice.

Kynect, the state’s health insurance exchange, opened its first retail store on Thursday across from the popular smoothie restaurant in one of Lexington’s busiest shopping centers. Kynect has been lauded for signing up more than 521,000 people for health insurance, cutting the state’s uninsured rate by 8.5 percentage points -the second highest drop in the nation after Arkansas.

Now, with the second open enrollment period beginning Saturday, state officials are turning their attention to the hard-to-reach groups that they missed the first time, including the so-called “young invincibles,” people in their 20s and 30s who don’t think they need health insurance because they are young and healthy.

The store should help officials target that audience, along with a new mobile phone app designed to help people determine eligibility for various plans offered on the exchange.

“I hope we will find thousands and thousands more and I’m confident that we will,” Democratic Gov. Steve Beshear said during the store’s grand opening. “We’ve got some things for free, and that’s pretty good for Black Friday.”

But it’s the free stuff that has state Republicans worried. If enrollment trends continue, many of those people won’t purchase private plans on the exchange. Instead, they’ll be added to the state’s Medicaid program, the government-funded health insurance service that the governor expanded under the federal Affordable Care Act.

Of the 521,000 people who received health insurance through kynect during the first open enrollment period, about 436,000 - or about 84 percent - were added to Medicaid rolls. That has left Republicans fretting about how the state will pay for those services beginning in 2017, when the state will start sharing the program’s cost with the federal government.

House Republicans estimate that, based on the number of people added to the Medicaid rolls so far, it will cost the state up to $250 million between 2017 and 2020. In 2017 alone the cost could be as much as $90 million, said state Rep. Bob DeWeese, the ranking Republican member of the House Health and Welfare Committee.

Kentucky ended the 2013-14 fiscal year with a $90 million shortfall. On Monday, state budget analysts said they could end the current fiscal year with a shortfall of as much as $135 million, based on lackluster tax collections in the first quarter. That left DeWeese and Republican state Senate President Robert Stivers voicing concern about the state aggressively seeking to boost its Medicaid rolls.

“We’re facing a deficit in Frankfort and unlike the federal government, we cannot print money,” DeWeese said. “How are we going to do the things we need to do now while trying to anticipate how much the Medicaid expansion will cost in order to balance our budget?”

Beshear said it’s impossible to know what the state’s share of the Medicaid expansion will cost. He said the expansion has helped the state save about $160 million in other areas of its budget, including shifting some costs for community mental health centers, local health departments and county jails to the federal government.

“All these factors will impact the final calculations,” he said.

The governor also said expansion could help lower medical costs by increased preventative care. Since expanding Medicaid, Beshear said breast cancer screenings are up 20 percent, colorectal cancer screenings are up 17 percent and adult dental visits have increased by one-third.

Beshear added that the mall’s kynect store will help continue the trend, offering flu shots and health screenings twice a week.

“I can’t think of a better time to open up this store and especially be here at Fayette Mall during the holiday season,” he said. “Because what better gift can you give than health.”

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