A look back: Kentucky healthcare reform from Governor Jones until now
Many Kentuckians have been remembering the Commonwealth’s 58th governor this week. Friends and family came to the State Capitol Monday where Brereton Jones was lying in state.
One of his driving ambitions while governor was to see more citizens find and be able to afford healthcare services.
Former Governor Brereton Jones held the top job in state government from 1991 until 1995. Joe Lilly came to serve in the governor’s press office and saw firsthand his interest in taking steps to improve the health of Kentuckians.
“He was so passionate about healthcare reform and even before he became governor, before he became lieutenant governor, he had worked on programs that would help poor people get access to health care,” said Lilly.
Lilly was one of many in the long line which stretched out through the main entrance to the Capital who came to pay respects. Another was Crit Luallen, a two-term state auditor and lieutenant governor. Luallen also served in the Jones administration, as cabinet secretary in tourism and then finance and administration.
“Well Governor Jones was ahead of his time. He saw and knew that a state like Kentucky could only lift itself up eventually in economic and educational rankings if we had a healthier population. So, he looked for every way he could to make healthcare more accessible to people all over Kentucky,” said Luallen.
Rocky Adkins was a state representative from Sandy Hook in eastern Kentucky when healthcare reform hit the House floor in 1994. Adkins said Jones was the first governor to really talk about healthcare reform. And the current senior advisor in the governor’s office said Jones knew a strong economy not only needed healthy people but access to good healthcare was important in recruiting industries.
Following Jones in the governor’s office was Paul Patton who this week said his predecessor was correct on the issue.
“It was very important, and he was right. It’s just that a state couldn’t do it by itself. It had to be a national issue. We fought as hard as we could to preserve his program, but it just couldn’t be done,” said Patton.
That program was contained in House Bill 250, and that piece of legislation had quite the time in the Kentucky General Assembly with lots of legislative theatrics including stopping the clock a few minutes before midnight to take a vote.
HB 250 was Kentucky state government’s version of healthcare reform during the 1994 session. Then Lexington Representative
Ernesto Scorsone was the key sponsor. He said the aim, based on consultant suggestions, was to try to standardize the health insurance market, allowing citizens to compare plans and create real competition.
“Obviously we followed their advice, cause it sounded pretty good, ideally a way to change the market, not eliminate the private market, but put some guideposts and hopefully make it a little more affordable and manageable for people to wade into,” said Scorsone.
Scorsone noted it’s hard to put leverage on big insurance companies because, in the big picture, Kentucky is a small market. He added a bunch of insurance companies left the state because they didn’t like the rules imposed.
Several people reflecting on former Governor Jones work on healthcare reform said his efforts set the stage for national reforms. One example would be prohibiting insurers from denying coverage based on pre-existing conditions.
And today, Scorsone said success in allowing Medicare to negotiate for drug prices, for instance, may be a precursor to more reforms.
“Maybe there’ll be a greater political will to do more of these things, to wrangle, if you will, the insurance company. I mean, not every country has healthcare as a big for-profit operation. A lot of people see it as a not-for-profit thing,” said Scorsone.
Despite not meeting the end goal, Scorsone says the executive and legislative efforts amounted to government at its finest. He said it was not a self-interested push by government, adding it was, quote, “the leadership trying to do something for the common good.”
And healthcare remains a key subject in Frankfort even today. Leitchfield Senator Stephen Meredith chairs his chamber’s Health Services Committee. And he puts the price of healthcare in the U.S. at a crisis level.
“Right now, it represents about 18% of our gross national product and it keeps growing. And quite literally if this thing pushes past 20% of our gross national product, I think it could very well collapse the economy of the United States,” said Meredith.
When it comes to any remedies Meredith said low hanging fruit is found in addressing administrative costs. He noted cutting the number of Medicaid managed care programs in half would be a step in that direction. Meredith added cost-shifting occurs when Medicare and Medicaid reimbursements don’t fully cover hospital costs. The retired hospital administrator said more emphasis should be on maintaining the health of Kentuckians rather than treating sick people.
“We do that by investing in primary care which has been really neglected in Kentucky. In Kentucky, 40% of our population is rural but only 17% of our primary physicians are in rural. And if you don’t address that situation, then people become more critically ill and that’s more expensive in the long run,” said Meredith.
If healthcare-related costs continue to climb, Meredith said the only option might be to turn it over to the federal government, something he adds would be a mistake. He asks, quote, “do you want the federal government to have control of 20% of your economy?”
It’s a sure thing there will be some type of healthcare reform legislation considered during the 2024 General Assembly session. Although maybe not to the same extent, it would be 30 years after HB 250 emerged out of Frankfort.
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