As Republicans in Congress prepare to repeal and replace former President Barack Obama’s health care law, Kentucky’s current governor and his predecessor are wrestling over the law’s legacy – and both sides claim the state as a case study of the law’s impact.
Former Democratic Gov. Steve Beshear embraced the Affordable Care Act, expanding Kentucky’s Medicaid program and setting up a state-run health insurance exchange. But Matt Bevin, Beshear’s Republican successor, quickly dismantled the state exchange and has applied for a waiver to overhaul Medicaid with the goal of moving people off the publicly-funded program and onto private insurance plans.
Their public feud was on display to a national audience Tuesday night, when Republican President Donald Trump quoted Bevin in a speech before Congress saying the Affordable Care Act is “unsustainable and collapsing” in Kentucky. Democrats turned to Beshear to give a nationally televised response, where he said the health care law brought coverage “for over half a million Kentuckians.”
Kentucky has long been held up as an example of how the Affordable Care Act should work. When the original roll-out of healthcare.gov was plagued by technical problems, Kentucky’s state-run exchange, dubbed kynect, ran smoothly. The exchange, combined with an expansion of the state’s Medicaid program, brought health care coverage to nearly 500,000 people. It lowered Kentucky’s uninsured rate from more than 20 percent to 7.5 percent, tied for the largest drop in the nation.
But the program has been more expensive than originally projected. Twice as many people signed up for the expanded Medicaid program as people predicted, costing taxpayers an extra $257 million in the most recent spending plan. A nonprofit health cooperative funded with a multi-million federal loan failed, and several private insurers have stopped offering plans on the federal exchange in Kentucky.
Still, Beshear noted the law has brought health coverage to more than 11 percent of the state’s people, many of whom live in rural areas and never had insurance. The law also greatly expanded treatment for drug addictions, of particular importance to Kentucky which has been hit hard by widespread abuse of prescription drugs, heroin and other opioids.
“Kentuckians are doing better because they have health insurance now and get to go to the doctor and be treated,” Beshear said.
Bevin says what the Affordable Care Act brought to people was not health insurance, but entitlement. He says the state cannot afford to pay for its growing Medicaid program, which now covers more than 25 percent of the state’s population. But while he dismantled Kentucky’s state-based exchange, he indicated he would not favor eliminating the federal health insurance exchange, where people can purchase private health plans with the help of a federal subsidy.
“There needs to be an onramp,” Bevin said. “I’ve not heard anybody who is credible say `get rid of the federal exchange.”‘
He said the increased access to health coverage hasn’t made Kentuckians healthier. Kentucky had the third-highest rate of drug overdose deaths in 2015, and it has the highest smoking rate and highest incidence rate of tobacco-related cancer in the country.
“(Beshear’s) comments were not grounded in reality,” Bevin said. “They are an attempt to desperately try to justify decisions that were made and preserve a legacy that, frankly, doesn’t even exist. It was embarrassing.”
A recent study published in JAMA Internal Medicine found that low-income people in Arkansas and Kentucky, which expanded its Medicaid program, had better access to care and were generally healthier than people in Texas, which did not expand Medicaid.
“Gov. Bevin simply denies those facts and would like to make up his own, I guess, but there aren’t any other facts out there,” Beshear said.
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