The Kentucky Obamacare debacle: How the state's crackpot new governor could sabotage a huge health reform success story

Matt Bevin's victory in Kentucky gives the GOP a real shot at harming Obamacare. They may not like the results

Published November 4, 2015 6:27PM (EST)

  (AP/Timothy D. Easley)
(AP/Timothy D. Easley)

Kentucky continues being a land of false hope for Democrats. Last year there was some guarded enthusiasm that Alison Lundergan Grimes might knock down (or at least convincingly challenge) high-ranking Senate fossil Mitch McConnell in his bid for re-election, but she ended up getting blown out by the ascendant majority leader on Election Day. And last night, heading into the Kentucky gubernatorial election, Democrat Jack Conway was viewed as a slight favorite over Republican Matt Bevin, but it was Bevin who came out comfortably on top once the votes were tallied, making him just the sixth GOP governor of Kentucky in the last century. The Bluegrass State seems to be busily putting the last touches on the broader disintegration of the Democratic Party in the old Confederacy.

So that’s not great news for Democrats, but the more immediate concern raised by Bevin’s victory is what will happen to the hundreds of thousands of Kentucky residents who have benefitted from the state’s enthusiastic embrace of the Affordable Care Act. Kentucky stands out as one of the ACA’s unquestioned bright spots. Departing Democratic governor Steve Beshear expanded Medicaid and set up a state-based insurance exchange, Kynect, which resulted in a massive reduction in Kentucky’s uninsured rate – in 2013 it stood at 20.4 percent; today it’s down to 9 percent. Instances of uncompensated care at Kentucky hospitals dropped, preventative screenings for cancer and other diseases increased, and over 16,000 previously uninsured children gained coverage.

But Bevin ran, and won, on a promise to do wholesale violence to the health reform law within the state. He’s promised to do away with Kynect – which, again, has been a huge success – and instead make use of the federally run healthcare marketplace. What’s more worrisome is Bevin’s clear-as-mud position on what will happen regarding the state’s expansion of Medicaid. Depending on which statement you choose to believe, Bevin will either undo the expansion altogether, or he will petition the Department of Health and Human Services to obtain a retroactive waiver to “tweak” the expansion and add barriers to access while throwing in some free-market bells and whistles.

Either way, Bevin’s plan for Kentucky is to “reform” a healthcare law that is working very well and make it less comprehensive and less effective for no real reason other than Barack Obama passed it and Barack Obama is very bad. This is ideologically satisfying for a great number of people, but it will also almost certainly result in fewer people having access to healthcare. This fact is one that has bedeviled conservatives and Republicans for years now as they’ve tried to work out the “replace” part of “repeal and replace Obamacare.” What they’ve never had to grapple with is a real-live rollback of the ACA in a place where it’s been fully implemented. Promising to obliterate Obamacare may sound good and tough on the stump, but actually going through with it means taking away people’s healthcare coverage.

If Bevin does go through with it – and there’s no real reason to think he won’t – he’ll likely be praised by conservatives and Republicans for striking a real blow against the Obama administration’s hated healthcare reform. But it will come with costs. Every Democrat and liberal in the country is going to be ready and waiting for stories of coverage cancellations, once treatable health problems left to fester, and the opening of a previously non-existent Medicaid coverage gap. Once the uninsured rate starts to creep back up, Kentucky could suddenly become a cautionary tale of what happens when Obamacare repeal – the promise of every Republican candidate and one of the chief justifications for electing a Republican president – is actually put into practice.

This was the same danger Republicans faced when they were loudly encouraging the bad-faith Supreme Court case challenging the legality of the Affordable Care Act’s federal marketplaces subsidies. It’d be one thing if Kentucky’s Obamacare experience had been underwhelming or disastrous, but it’s actually done real, tangible good in the state. Bevin promised to sabotage that progress, and if he follows through on that pledge, Republicans may not like what they see.

KY Governor Race Big Election Day Surprise

By Simon Maloy

MORE FROM Simon Maloy