If you’re wondering why the Democrats selected former Kentucky governor Steve Beshear to deliver their response to Donald Trump’s speech in front of joint session of Congress on Tuesday, look no further than the Bluegrass State’s experience with Obamacare. According to Bloomberg, “at the beginning of 2016, almost one in three Kentuckians had Medicaid or insurance through a federally subsidized Affordable Care Act plan.”
More impressively:
Within two years [of enactment of the Affordable Care Act], the state’s uninsured rate had fallen to 6 percent of the population from 20 percent. More than 420,000 people had been insured through Medicaid expansion, dropping the number of uninsured in some low-income jobs — at restaurants, construction sites, gas stations and discount stores, among others — by between 35 percent and 52 percent, according to data from the Kentucky Center for Economic Policy, which studies impacts on the poor.
If you listen to the current governor of Kentucky, however, you will learn that none of these people were actually able to access health care.
…Gov. Matt Bevin, a Republican from Kentucky, argued that coverage numbers aren’t a good metric to measure health plans by.
“What do we want out of the health care system? We want healthier outcomes,” he told reporters. “That should be the ultimate goal. Simply enrolling people serves absolutely no value if all we’ve given them is a plastic card that says you’re now covered. They take that to a doctor who won’t see them.”
Not that it will help Gov. Bevin’s case, but he was referring to a different set of metrics. He was looking at the results of a study that McKinsey & Company put together for the National Governors Association. It looks at what will happen if a House Republican plan to “repeal and replace” Obamacare is passed and signed by President Trump.
The analysis includes graphs on what the Republican plan to overhaul Obamacare’s tax credits, generally making them less generous, would do. They are based on the recent 19-page proposal that Republican leadership released about their plan to repeal and replace Obamacare. In particular, they look at the effect of switching from income-based tax credits (which give poor people more help) to age-based tax credits, where everyone would get the same amount.
The report estimates what would happen in a hypothetical state with 300,000 people in the individual market that has also expanded Medicaid. In the individual market, enrollment would fall 30 percent and 90,000 people would become uninsured.
An additional 115,000 people in that hypothetical state may also lose coverage because they are enrolled in Medicaid and cannot find an affordable private plan.
Depending on how you look at it, things would look even grimmer in states that did not expand Medicaid. Do you worry that over 50% of Obamacare enrollees in your non-expansion state would lose their insurance and be left with no affordable access to health care, or are you happy that your federal funding would only fall by 6% instead of by the 24% experienced in the states that did expand Medicaid.
The answer to that question will help determine just how much of a heartless ideologue you really are.
Now, Gov. Matt Bevin campaigned on repealing Obamacare but he didn’t quite manage to do it. He made it look like he was doing it by closing new enrollment in the popular individual Kynect market. But that just forces folks to use the federal webpage and stop pretending that Kynect wasn’t Obamacare by a different name.
As for Medicaid, well…
Instead of scrapping Kentucky’s expanded Medicaid, Bevin applied for the same kind of federal waiver won by other Republican governors, led by Pence. The waiver programs include Republican-looking add-ons — premiums, punishments, so-called skin in the game for the poor — that allowed the governors to expand Medicaid under Obamacare, while saying they were doing something else.
Bevin had to make his peace with Obamacare but that doesn’t mean he isn’t rooting for the Republicans in Congress to screw his constituents in the same uncomfortable places he was too squeamish to screw them himself. So, when presented with a study showing just how badly his people will get reamed by the House Republicans’ plan, he tells us that all they’ll be losing is a worthless plastic card that wouldn’t even allow them to see a doctor.
That’s his spin.
And he hopes he can get away with it because of another statistic:
Kentucky pushed Obamacare as anything but Obamacare in order to sidestep political hostility to the president, whose position on coal made him unpopular in a state with roughly half the coal jobs it had in 2010. Enrollees signed up for Kynect, the state’s brand of the health-law insurance, not Obamacare.
If Kentuckians want to hold a coal grudge, they’ll get more of the governance provided by Bevin and less of the tangible improvements in their lives provided by Gov. Beshear. Maybe they’ll figure this out when Beshear responds to Trump on Tuesday.
Even if they never get it, the Democrats are hoping that the rest of the country can figure it out.
