Kentucky: Microcosm for National Healthcare Debate

November 9, 2015

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Kentucky has always been the best state in America for bluegrass, horse racing and bourbon. But Kentucky is also gaining national recognition in an unexpected area: becoming a microcosm for the national debate over Obamacare.

On Tuesday night, voters elected Republican Matt Bevin to succeed Democrat Steve Beshear as the state’s next governor. Beshear created one of the few State-Based Health Insurance Marketplaces, KYNECT, and expanded Medicaid eligibility for people with income just above the federal poverty line. As a result, nearly half a million residents – one in 10 Kentuckians – gained coverage through Medicaid or KYNECT, and the state has seen a significant drop in the uninsured. In fact, Kentucky’s results are some of the best in the nation, and the state is the only place in the southeast quadrant of the U.S. to see a significant decline in the number of residents without health insurance.

Obamacare supporters are worried that the change in parties in the Governor’s Mansion will mean a dismantling of KYNECT and a reversal of the Medicaid expansion. During his campaign, Bevin initially announced he would undo the Medicaid expansion, which has covered 400,000 adults in the state. But shortly before election night, Bevin said he would keep Medicaid expansion in place and make some conservative reforms to the program.

Bevin has yet to comment on his plans for the state-based insurance marketplace. If he decides to scrap the program, Kentuckians would still be able to sign up for coverage through HealthCare.gov, the federal Marketplace, but this is leading to confusion for Kentuckians who have coverage through the state exchange.

In many ways, Bevin’s “repeal and replace” plan in Kentucky echoes the debate in Washington. But Bevin will likely run into the same issues that have snagged Republicans in Congress. It’s much more difficult to take away health insurance from people than it is to block efforts to expand coverage under Medicaid. As of September 2015, the Department of Health and Human Services reported a total of 17.4 million Americans are covered due to the Affordable Care Act’s (ACA) Marketplace, Medicaid expansion, young adults staying on their parents’ plans and other coverage provisions.

House and Senate Republicans are working toward votes in both houses of Congress this fall to repeal all or big parts of the ACA. If they can somehow succeed, President Obama has promised to veto such legislation and the votes aren’t there for Congress to override him. What of 2016? All of the Republican presidential candidates have pledged to repeal Obamacare as soon as they are in office. If the GOP is successful in gaining the White House and holding onto its majority in Congress, will that be the death knell for the ACA? Or will national Republicans face the same reality as the leaders of the Bluegrass State are confronting today?

If I had to place a bet on this horse race, I would wager a new Republican president would end up taking the Bevin route and offer Republican reforms to the existing law before taking health coverage away from millions of people. If I’m wrong, next round of Kentucky bourbon is on me.

UPDATE: Right after this blog posted, Governor-elect Bevin elaborated on his plans. He announced his intent to dismantle the state-based Marketplace, KYNECT, by the end of next year. He also provided some insight into his plans for Medicaid Expansion in the state, announcing a “private option” similar to other states like Arkansas, but promises the plan “isn’t an attempt to cut people off.”