ACA op­po­nents boosted by Ken­tucky, Vir­ginia elec­tions

Modern Healthcare - - NEWS - By Vir­gil Dick­son and Har­ris Meyer

A year ago, Pres­i­dent Barack Obama strug­gled to ex­plain why so many white work­ing-class Amer­i­cans op­pose his health­care re­form law, even those who ben­e­fit from it. He blamed the per­cep­tion that the ACA mostly helps mi­nor­ity and poor peo­ple.

Ken­tucky, he said, “is one of the best states in us­ing the Af­ford­able Care Act to in­sure huge num­bers of work­ing­class white vot­ers. It’s just they don’t call it Oba­macare. They call it some­thing else.”

But the law’s suc­cess, along with Democrats re­brand­ing it, wasn’t enough to save Ken­tucky At­tor­ney Gen­eral Jack Con­way from its un­pop­u­lar­ity in the state’s gu­ber­na­to­rial elec­tion last week. He stressed that the state’s Med­i­caid ex­pan­sion and the state-run Kynect ex­change—which to­gether ex­tended cov­er­age to more than half a mil­lion res­i­dents— were home-grown. Many Democrats called it Bes­hearcare, af­ter the state’s pop­u­lar two-term Gov. Steve Bes­hear, who im­ple­mented both pro­grams through ex­ec­u­tive or­der.

The cov­er­age ex­pan­sions cut Ken­tucky’s unin­sured rate in half to un­der 10%. Char­ity care at eight Ken­tucky hospi­tal sys­tems fell 38% in 2014, while un­col­lectable debt fell 12%, ac­cord­ing to the Mod­ern Health­care Financial Data­base.

Nev­er­the­less, in an elec­tion closely fol­lowed by the na­tional me­dia, Repub­li­can busi­ness­man Matt Bevin un­ex­pect­edly routed Con­way to be­come the state’s next gover­nor. Bevin ini­tially had promised to undo the Med­i­caid ex­pan­sion, which ac­counted for 4 out of ev­ery 5 Ken­tuck­ians who re­ceived new cov­er­age. He now plans to seek a waiver like In­di­ana’s, halt new en­roll­ment, and tighten in­come el­i­gi­bil­ity cri­te­ria. He also vowed to shut down Kynect and turn its func­tions over to the fed­eral ex­change.

That wasn’t the only po­lit­i­cal drub­bing Oba­macare took Tues­day. GOP vic­to­ries in Vir­ginia’s state leg­isla­tive elec­tions snuffed out Demo­cratic Gov. Terry McAuliffe’s hope of ex­pand­ing Med­i­caid. “By hold­ing onto the state Sen­ate, Repub­li­cans have en­sured that Med­i­caid ex­pan­sion will not hap­pen in Vir­ginia in the near fu­ture,” said Ge­of­frey Skel­ley, a Univer­sity of Vir­ginia po­lit­i­cal an­a­lyst.

ACA sup­port­ers fear th­ese elec­tion re­sults will en­cour­age Repub­li­cans to cam­paign ag­gres­sively against the law in the 2016 elec­tions in the be­lief most vot­ers have lit­tle sym­pa­thy for those newly cov­ered. Polls show the gen­eral pub­lic re­mains about evenly di­vided on the law.

Last week’s bal­lot re­sults were a bit­ter pill for Obama and the Democrats, who had hoped the ACA would help them hold the White House and re­cap­ture the Sen­ate in 2016. They had thought ACA pro­vi­sions aimed at the gen­eral pub­lic—such as guar­an­teed cov­er­age for those with pre-ex­ist­ing health con­di­tions—would give them a pow­er­ful po­lit­i­cal boost.

But nu­mer­ous polls and me­dia in­ter­views show even peo­ple el­i­gi­ble for ACA cov­er­age don’t al­ways ap­pre­ci­ate the law’s ben­e­fits. “I don’t love Oba­macare,” Louisville res­i­dent Amanda May­hew told the New York Times last year, even though she had been to the den­tist five times to save her ne­glected teeth and gums af­ter be­com­ing el­i­gi­ble for Ken­tucky’s ex­panded Med­i­caid pro­gram.

GOP strate­gists are al­ready look­ing to cap­i­tal­ize on Bevin’s vic­tory. It “will em­bolden Repub­li­cans and give mo­men­tum to re­peal­ing and re­plac­ing Oba­macare as a 2016 cam­paign is­sue,” said Bradley Blake­man, a GOP strate­gist and prin­ci­pal at the 1600 Group.

The next test of the pub­lic’s mood will come on Nov. 21, when Louisiana vot­ers choose be­tween Demo­crat John Bel Ed­wards and Repub­li­can David Vit­ter for gover­nor. Cur­rent Gov. Bobby Jin­dal, a GOP pres­i­den­tial can­di­date, has fiercely op­posed the ACA and Med­i­caid ex­pan­sion. Ed­wards says he would straight­for­wardly ex­pand Med­i­caid, while Vit­ter says only that he would con­sider some form of ex­pan­sion.

Bevin ben­e­fited from low turnout by lower-in­come peo­ple who gained most from the cov­er­age ex­pan­sion. ACA foes “were more likely to be ac­ti­vated and more likely to turn out,” said Glen Mays, a pro­fes­sor of health ser­vices at the Univer­sity of Ken­tucky. Less than a third of reg­is­tered vot­ers cast bal­lots.

Last month’s clo­sure of the Ken­tucky Health Co­op­er­a­tive, a not-for-profit co-op plan cre­ated un­der the ACA, also may have helped Bevin, who said it demon­strated Oba­macare’s fail­ure. The plan’s shut­down means 51,000 Ken­tuck­ians must switch plans for 2016.

Given that Bevin’s anti-Med­i­caid ex­pan­sion stance soft­ened dur­ing the cam­paign, re­form ad­vo­cates are now hop­ing much of the cov­er­age ex­pan­sion will re­main in place once he takes of­fice. “Ken­tucky’s Med­i­caid ex­pan­sion has been pop­u­lar,” said Ni­cole Hu­ber­feld, a law pro­fes­sor at the Univer­sity of Ken­tucky. “I would be sur­prised if he un­does all of the work that the Bes­hear ad­min­is­tra­tion has per­formed so well.”

Ken­tucky Gov.-elect Matt Bevin cam­paigned against

Oba­macare and Med­i­caid ex­pan­sion.

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