Meanwhile Here In Bevinstan

Since Republicans in Washington can't wreck Medicaid fast enough for Kentucky GOP Gov. Matt Bevin, his plan is to take the nation's most successful Medicaid expansion under Democrat Steve Beshear and turn it into some crazy deal involving coupons and rewards, because your health care should completely be like your grocery store loyalty card.

From a glance at Bevin’s proposal, it’s easy to mistake the “MyRewards” idea for an expansion of coverage. The changes are described as “benefit enhancements” in a new, detailed implementation proposal from the consulting firm Deloitte. 

Bevin’s plan is in fact a benefit cut. Kentucky’s Medicaid program currently includes vision and dental. If you’re eligible for Medicaid in Kentucky, then you’re eligible for coverage of regular tooth checkups and eye exams under state law. 

Bevincare would “enhance” Medicaid benefits by taking several of them away. You will lose the security of knowing your eye doctor and dentist will see you when you need them, and gain the exciting new opportunity to earn chits toward the cost of those same services. 

But to accrue those chits, you must live by Bevin’s rules. MyRewards points accumulate based on the enrollee’s participation in job training, health screening, smoking cessation, volunteer, and educational programs, at the rates listed below: 

CREDIT: Kentucky HEALTH Program Requirements Specification 

Bevin’s behavioral incentives effectively convert his definition of good character into a state-enforced moral code which everyone who can’t afford health insurance must follow — and whose compliance the state must monitor. 

“This requires building a massive database about people’s individual behaviors, and then keeping it up. Never mind that it’s massively expensive, it also feels very invasive,” former Centers for Medicare and Medicaid Services (CMS) administrator Andy Slavitt said in an interview. “I’m not sure the government should be tracking if I put on five pounds, or if I’m advancing in my job, or what grade I got on my GED exam.”

It's weird, it's almost like the notoriously "libertarian" Bevin has a plan set up to make a government program so invasive and obnoxious that people won't want to put up with the hoops required to stay on Medicaid.  Why, it's almost like the GOP response to legal goods and services that they don't think the poor deserve is to make the requirements for getting it so impossibly high that few ever bother with the attempt.

Now if you want Medicaid services, you have to check in with Kentucky and sign up for job skills coaching, community service, job searching and more.  After all, the real goal isn't to get you healthy, the goal is to get you to the point where you no longer qualify for Medicaid and are no longer the commonwealth's problem.

We've got to gamify health care, after all.  And if you can't actually perform these activities, well, too bad.  No vision and dental coverage for you, in a state that already has one of the worst dental coverage rates in the nation.  Good job!

But that's the new game in town here in Bevinstan.