- Associated Press - Monday, March 30, 2015

LOUISVILLE, Ky. (AP) - Kentucky can’t sustain the cost of expanded Medicaid enrollments under the federal Affordable Care Act and needs to cut the rolls, Republican gubernatorial hopeful James Comer said Monday while promoting his health care plan.

Speaking to a group that included health care executives, Comer said if he’s elected governor in November he would review eligibility standards for Kentucky’s Medicaid, the government health insurance program for the poor and disabled.

His goal is to shift people off Medicaid and into private health insurance plans, Comer said.

More than half a million people have signed up for health insurance through kynect, the state-run health exchange, but most of those Kentuckians have enrolled in Medicaid. Kentucky was among the states that expanded Medicaid under the Affordable Care Act. So far, the federal government has picked up the entire cost of the expansion. But beginning in 2017, Kentucky taxpayers will start paying for part of the bill.

Currently, about one in four Kentuckians are signed up for Medicaid, Comer said.

He didn’t offer specifics on changing eligibility, but said the state can’t sustain Medicaid rolls at those levels.

“We’re going to have to set it at a level to where the taxpayers can afford it,” he said. “Every option’s going to be on the table, but I can tell you right now we cannot afford to keep 25 percent of the state on Medicaid.”

Many recipients deserve the benefits, Comer said, but “able-bodied adults” have been added to Medicaid rolls as part of the expansion carried out by second-term Democratic Gov. Steve Beshear, who can’t seek re-election due to term limits.

Medicaid enrollees undergo a yearly recertification to determine if they continue to meet eligibility standards, said Gwenda Bond, a spokeswoman for the state Cabinet for Health and Family Services. The Medicaid expansion has provided health insurance for many of Kentucky’s working poor, she said.

“Thousands of the adults who qualified for Medicaid expansion are not only able-bodied but they’re already working,” she said. “They were working before Medicaid expansion, too, but their jobs either didn’t offer health benefits or they couldn’t afford them.”

Comer, the state’s current agriculture commissioner, is locked in a heated campaign ahead of the May 19 GOP primary for governor.

His rivals are former Louisville Metro Councilman Hal Heiner, former state Supreme Court Justice Will T. Scott and Louisville businessman Matt Bevin, who failed to unseat now-Senate Majority Leader Mitch McConnell last year.

The federal health care overhaul engineered by President Barack Obama is widely condemned by Republicans. Comer urged Congress to repeal it, calling it the worst law of his lifetime. But the next governor will have to deal with it, barring the unlikely scenario that it’s repealed.

Beshear says the health care law will change Kentucky’s woeful health statistics - and improve its business competitiveness - by expanding health coverage to people who had been uninsured. Kentucky is plagued by some of the nation’s worst rates for cancer and cardiovascular deaths. Obama has singled out Kentucky’s as a national model for its health care sign-ups.

Comer said Kentucky’s health exchange has turned into “a tool to greatly expand Medicaid.”

As for the future of kynect, Comer said there would be costs associated with keeping it or disbanding it.

“All options with regard to kynect will be on the table,” Comer said if he’s elected.

The way to shift many Medicaid recipients into the private health care market is to attract more businesses to Kentucky, he said. Comer noted that his administration would award state tax incentives only to companies paying “living wages” with benefits.

“We shouldn’t give tax incentives to companies that have a high percentage of employees that don’t make a ‘living wage’ and end up on Medicaid,” he said. “That’s double subsidizing those companies.”

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