FRANKFORT, Ky. In his mid-30s, Jonathan Hensley was unemployed and caring for some disabled family members. He needed to take care of himself, too, because his teeth hurt.
Historically in Kentucky, someone like Hensley – a single, able-bodied adult with no job — would likely not have had health insurance. But because the state expanded its Medicaid program under the Affordable Care Act in 2013, Hensley and some 400,000 other Kentuckians got taxpayer-funded medical, dental and vision coverage.
Hensley, now 37, got some needed fillings.
That routine dental coverage is now at risk, as Gov. Matt Bevin seeks to overhaul the state’s Medicaid system. The Republican governor’s proposal would eliminate routine dental and vision coverage for Medicaid recipients, but allow them to earn those benefits back by doing things like volunteering, undergoing a health assessment and getting a job.
Bevin administration officials say axing dental and vision coverage is a significant portion of the estimated $2.2 billion in taxpayer savings the changes to Medicaid would bring. The proposal also encourages people to take responsibility for their health, the officials say.
But health advocates say the plan would put up a barrier between the poor and access to dental care, setting up a battle in this Appalachian state where more than half of adults 18 or older have had a tooth pulled because of decay or gum disease.
“(Bevin) wants to say, ‘Oh it’s about providing dignity.’ How is it providing dignity to sit here and say, ‘You can’t have vision, you can’t have dental because you are a lazy bastard who is sucking on the government teat,” Hensley said. “It’s not because people don’t want to work, people want to work. They can’t get jobs and they can’t get good paying jobs.”
In Clay County, where Hensley lives, unemployment is at 11.1 percent, more than twice the U.S. rate of 4.9 percent. Most eastern Kentucky counties have unemployment rates in the double digits. They also have the highest populations, proportionally, of people on Medicaid. Experts say the use of dental health services across Kentucky’s rural counties has been low for a variety of reasons, including a limited network of providers and a general lack of understanding of the importance of dental health. But in the first year of Kentucky’s expanded Medicaid program, dental care surged by more than 100,000 people.
In Daviess County, more than 7,300 people enrolled in Medicaid after it expanded, the overwhelming majority of them adults, said Brandon Taylor, who runs the only dental clinic in the county that accepts Medicaid.
“Prior to that we frequently had patients come in with absolutely zero payer source,” he said.
