The off-year Kentucky governor’s election put the future of the Affordable Care Act into question in that state. Kentucky is the only southern state to have run its own ACA health insurance exchange, and go ahead with Medicaid expansion. And it’s been seen as a success. A half million people got covered, mostly under Medicaid. Uninsurance rates plummeted in 2014 more than in any other state – and Kentucky has more than its share of poverty and ill health.
Matt Bevin, the millionaire tea party GOP candidate, was elected on a pledge to undo most of it.
Precisely how far and how fast he’ll try to push back is not clear yet. During the campaign Bevin said he’d halt Medicaid expansion. Now he says he’ll keep it, but only after negotiating a waiver with the Department of Health and Human Services along the lines of what Indiana did. That would inject some conservative ideas and payment requirements into the health care program for low-income people. And even if Bevin dismantles the state’s successful exchange, known as Kynect, people in Kentucky would still be able to get coverage and subsidies through the federal exchange and HealthCare.gov. Campaign pledges notwithstanding, even the most conservative governor can’t “repeal” the ACA.
Amy Goldstein of The Washington Post traveled to Kentucky a few days after Bevin won by a surprisingly large margin. She interviewed “Kynectors” like Mindy Fleming, who are trained to enroll people in coverage. Fleming has signed up more than 1,000 individuals and families, but the Kynector program would dry up if the incoming governor closes the exchange. (Advocacy groups, clinics, and federally funded assisters could step in, but without the embrace of the state government.)
Goldstein also found people like Tiffany Coleman, whose daughter gets back-up coverage from a state Medicaid plan for a chronic bladder condition, even though the family now gets covered through the dad’s job.
She talked with Gary Ryan, 64, a former miner with liver disease who voted against Bevin partly because of the candidate’s stance on health care. Ryan had left Kentucky for work elsewhere, and only returned when the ACA meant he could get covered at home.
Most interestingly, she also found people like Dennis Blackburn, who has what she called a “splintered self-interest.” Blackburn voted for Bevin hoping he would create jobs, while fearing that he would take away the health insurance that he and his neighbors so badly need. She wrote:
The 56-year-old mechanic hasn’t worked in 18 months, since he lost his job at a tire company that supplies a diminishing number of local coal mines. “The old guy had to go home,” Blackburn says of his layoff.
He has a hereditary liver disorder, numbness in his hands and legs, back pain from folding his 6-foot-1-inch frame into 29-inch mine shafts as a young man, plus an abnormal heart rhythm — the likely vestige of having been struck by lightning 15 years ago in his tin-roofed farmhouse…
On Election Day, Blackburn voted for Bevin because he is tired of career politicians and thought a businessman would be more apt to create the jobs that Pike County so needs. Yet when it comes to the state’s expansion of health insurance, “it doesn’t look to me as if he understands,” Blackburn said. “Without this little bit of help these people are giving me, I could probably die. … It’s not right to not understand something but want to stamp it out.”
You can better understand the Republican attacks on Obamacare if you read Trudy Lieberman’s article in Harper’s, “Wrong Prescription? The failed promise of the Affordable Care Act.” http://harpers.org/archive/2015/07/wrong-prescription/
Obamacare is a Republican plan. She quotes Obama as saying, “We thought if we shaped a bill that wasn’t that different from bills that had previously been introduced by Republicans, including a Republican governor in Massachusetts who’s now running for president, that we would be able to find some common ground there. And we just couldn’t.”
Lieberman said that the purpose of the Republican attacks is to push the debate even further to the right, further from single payer, to a system in which “every single bargain-hunting American buys coverage directly from a private insurer.” Of course, peer-reviewed research shows that it’s impossible for most Americans to make free-market health care decisions.
Lieberman said the poor buy the Bronze plan, because it has the lowest initial premium, but then they can’t afford the deductible ($3,000 individuals, $6,000 families), so they can’t use it at all, and drop the policies once they realize that. One “consumer” said, “It ain’t worth a tooth.” The ACA is “also wreaking havoc on the middle class.”
Paul Ryan said that when they have a Republican President and Congress, they will convert Obamacare into a voucher plan. The problem with that, said Lieberman, is the vouchers will be too low, won’t keep up with inflation, and will have to compete with other items in the state general funds as the Republicans cut state taxes.
Obamacare’s fundamental flaw is its unwillingness to control high costs, which requires a politically impossible attack on the drug companies, insurers, hospitals and doctors, she said.
When Lieberman gave a talk at Physicians for a National Health Program, one audience member said Bernie Sanders could solve these problems.
You can also read her posts on CJR. http://www.cjr.org/author/trudy-lieberman-1/