Kentucky a unique lab for health law


The state’s online health insurance marketplace, called Kynect, at the Kentucky Bourbon Festival. (Phil Galewitz/Kaiser Health Network)
September 29, 2013

Behind the Jim Beam American Stillhouse and the Wild Turkey Sit N’ Sip Saloon at the Kentucky Bourbon Festival, a sales team pitches the Affordable Care Act.

But potential buyers are wary. On a late-September night — days before the launch Tuesday of the state’s online health insurance marketplace, called Kynect — most passersby are unaware of their new insurance options under the law, confused by the political sniping and doubtful the law will help them.

“I thought this was defunded,” said Carolyn Richards, 53, of Mount Sherman, who has been uninsured for a decade. She had heard that the Republican-controlled House had voted to cut off the funding for President Obama’s signature health-care law this month but was unaware that Senate Democrats and the White House were refusing to go along.

Politically divided, Kentucky is the only Southern state running its own Obamacare marketplace and one of two committed to expanding Medicaid, the state-federal health program for the poor, making it a unique bellwether of public receptivity to the law. While Gov. Steve Beshear is a Democrat, the state’s U.S. senators, Minority Leader Mitch McConnell and Rand Paul, are Republicans and ardent foes of Obamacare.

“If the law can go in Kentucky, it can go anywhere,” said Mark A. Rothstein, a professor of law and medicine at the University of Louisville.

The fierce and often nasty debate has made it a tougher sell, said Barbara Gordon of the Kentuckiana Regional Planning and Development Agency, one of two nonprofits designated to help consumers enroll. “People are confused by all the mixed messages,” she said.

But in Bardstown, which proclaims itself the world’s bourbon capital, there are signs the law’s advocates are making headway. Most of those interviewed interest in Kynect, saying they’ll check to see if they qualify for Medicaid or for federal subsidies.

Sharon Omstead, 46, who works at a factory labeling bourbon bottles and who calls Obama “the devil” for his economic policies, was surprised to learn that she’ll qualify for Medicaid and have to pay little or nothing for health coverage under the law.

“I’d heard a lot of bad things about the law and how it will make prices for health insurance go up, and how everyone will have to buy insurance even if they can’t afford it,” she said.

Pam Lux, 59, of Edgewood complained about insurers turning her away because of her diabetes and assumed that that would happen again until a Kynect worker informed her that such exclusions are prohibited under the law starting next year. “I’m glad to hear that,” she said.

About 17 percent of the state’s population, 650,000 people, lack insurance, a percentage a little higher than the national average, and many are poor. That’s the target population for Kynect. Its customer service center has received more than 4,000 calls since it opened Aug. 15. More than 5,000 people have registered for online training, including 3,500 insurance agents.

To get around the political stigma burdening the law, Gordon tells the staff assisting consumers — called navigators — that the Obamacare label is poisonous and to avoid it.

“For a lot of people in Kentucky . . . Obamacare has a negative connotation and if you say Obamacare, people pretty much shut down and won’t listen to anything beyond that,” she said.

On the other hand, Gordon said, Affordable Care Act “makes people’s eyes glaze over.” She coaches navigators to ask: “Do you need to connect to health care? Do you have health insurance? If not, let us help you.”

Kelli Cauley, 42, has an additional selling pitch as a navigator — she has hormonal problems that kept her from getting affordable coverage for 18 months. “I was looking forward to the changes under the law and am looking forward to providing unbiased information because there are so many misconceptions going on,” she said.

Beshear acknowledged in an interview that the public debate is confusing, “and obviously that’s the intent.”

“But I think opponents of the law are scared to death of being in position a year from now, where people look at them and wonder what all the noise was about as they sit here with an insurance policy that they can afford,” he said.

Not all consumers may feel that way.

Kathryn Hicks, 58, has thyroid and lung problems and is uninsured. Her $310-a-week cashier job at Ace Hardware in Louisville means she probably will make too much to qualify for Medicaid, though she will qualify for subsidized private coverage.

But she said she could not afford to pay even $100 a month for coverage. “I have to decide between paying the power company or whether to eat,” she said.

Kaiser Health News (www.kaiserhealthnews.org) is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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