Kentucky Secretary of State Alison Lundergan Grimes (D) and Senate Minority Leader Mitch McConnell (R-Ky.) during Monday’s debate. (Pablo Alcala/The Lexington Herald-Leader/Pool via AP)

“Kentucky Kynect is a Web site. It was paid for by a $200-and-some-odd-million grant from the federal government. The Web site can continue. But in my view, the best interest of the country would be achieved by pulling out Obamacare, root and branch…. Now, with regard to Kynect, it’s a state exchange. They can continue it if they’d like to. They’ll have to pay for it because the grant will be over. And with regard to the Medicaid expansion, that’s a state decision. The states can decide whether to expand Medicaid or not. In our state, the governor decided to expand Medicaid.

–Sen. Mitch McConnell (R-Ky.), in a campaign debate, Oct. 13, 2014

Many readers requested a fact check of McConnell’s Obamacare statements in his debate with the Democratic challenger, Alison Lundergan Grimes. It’s a very interesting set of statements, and we have puzzled over them till our puzzler was sore.

McConnell has some difficulty with the Obamacare issue because the Kentucky version, known as Kynect, has been a huge success. About half a million Kentuckians signed up for health insurance, many receiving it for the first time. Fewer than 100,000 joined private insurance plans; that means the bulk of the population joined Medicaid, which was greatly expanded under the Affordable Care Act, a.k.a. Obamacare.

But at the same time, Obama is deeply unpopular in Kentucky and polls indicate that many Kentuckians do not associate Kynect with Obamacare. So McConnell threads a very difficult needle here, suggesting the Web site can continue while the law that created it must be scrapped.

How realistic is this?

(Note: In his remarks, McConnell also made a number of other assertions for which we have previously awarded Pinocchios, including the claim that $700 million was taken out of Medicare to fund Obamacare, that the Congressional Budget Office said 2.5 million jobs would be lost and that insurance premiums have dramatically increased. For the purposes of this column, we will stay focused on his comments about the Web site.)

The Facts

In May, we had explored some of these issues in a lengthy back-and-forth with McConnell’s campaign manager at the time. We made no ruling at the time but noted: “Now we are left with a strange, even nonsensical situation. McConnell appears to be arguing that Kentucky can keep the parts of the law that residents apparently like, such as an individual health exchange and a costly expansion of the Medicaid program, even while dismantling the federal program that provides Kentucky with the program in the first place. That makes no sense.”

Let’s parse McConnell’s comments in the debate more closely.

First, his comments on the Web site: “Kentucky Kynect is a Web site. It was paid for by a $200-and-some-odd-million grant from the federal government. The Web site can continue… with regard to Kynect, it’s a state exchange. They can continue it if they’d like to. They’ll have to pay for it because the grant will be over.”

This is a politically clever gambit by McConnell, because he’s saying the popular Kynect would not disappear even if Obamacare is repealed.

In a narrow sense, McConnell is correct that the federal grant to build the Web site has ended and now states must maintain them on their own nickel. (A majority of states choose not to set up a Web site but simply have residents use healthcare.gov.) The law, in section 1311, states that no grants will be awarded after Jan. 1, 2015.

Of course, Kynect is more than just a Web site, but a delivery mechanism for health insurance. The insurance market is now functioning according to the rules of Obamacare, such as an individual mandate, premium subsidies and a defined package of benefits. If the Obamacare rule book disappears, what’s left to put on the Web site?

Avik Roy, an Obamacare critic who argues for not repealing the law but overhauling it,says that McConnell’s basic point is not that far-fetched—the exchange could be used as the basis for a different system unique to the state.

“I would fully expect blue states, like New York and California, to retain their health insurance exchanges even if Obamacare were repealed,” wrote Roy in Forbes. “Those states would be free to aggressively regulate insurance companies, as many states had done prior to Obamacare. They’d be free to impose individual mandates, as Massachusetts did in 2006. Even red states would have reason to develop market-based exchange alternatives, like Utah had done prior to Obamacare.”

Still, Roy noted, “Some have complained that McConnell is trying to have it both ways—by repealing Obamacare but not taking coverage away from those who have gained it—and that’s not an unfair take. But McConnell’s position isn’t that different from what conservative health policy types have been advocating for years: preserving Obamacare’s coverage expansion, but using a different mechanism to achieve it.”

But then there’s this McConnell statement: “The best interest of the country would be achieved by pulling out Obamacare, root and branch.” Note that McConnell does not really propose an alternative. He sticks with the pledge to repeal Obamacare without describing a replacement that could be used on Kynect.

His office pointed The Fact Checker to a previous statement in which McConnell said: “I will continue to lead efforts to repeal and replace it with commonsense patient-centered reforms that preserve greater choice for my constituents while also lowering costs.”  But McConnell has not backed the one comprehensive GOP replacement plan, introduced by his colleagues Richard Burr (R-N.C.), Tom Coburn (R-Okla.), and Orrin G. Hatch (R-Utah). His office suggested specifics would come during the regular committee process of crafting a bill.

Finally, there’s this comment: “With regard to the Medicaid expansion, that’s a state decision. The states can decide whether to expand Medicaid or not. In our state, the governor decided to expand Medicaid.

McConnell is again threading the needle very carefully here. The Medicaid expansion has certainly been popular in Kentucky, and he suggests it can stay in place if state officials want to keep it. But the Affordable Care Act pays for a substantial portion of that expansion, and it would be extraordinarily expensive for the state to maintain that coverage on its own. (We had earlier cited an estimate of at least $350 million a year.)

Of course, it is possible to replace that expanded Medicaid coverage with a different system that still kept those Kentuckians insured, even if they no longer stayed on Medicaid. The question, again, is: what is that system?

“The key with McConnell’s statements are: what kind of replace plan does he favor?  If he favors repealing Obamacare and doing nothing to replace it, then yes, those people would lose coverage,” Roy said in an e-mail.  “But my recollection is that McConnell is firmly in favor of replacing, which means that the real question people should be asking him is: what kind of replace plan does he favor, and would that plan cover the people who have gained coverage from the ACA?”

The Pinocchio Test

Ultimately, then, McConnell’s statements make little sense unless he has a specific plan that would allow Kentuckians who currently have insurance to retain it. He relies on narrow technical details that have a ring of truth—the grants for the Web site have ended; the Kynect Web site could continue; Medicaid expansion was a decision by the governor. But he leaves the big picture—What is his replacement plan?—completely empty.

Thus his statements are a bit slick and misleading. If he wants to rip out Obamacare “root and branch,” then he has to explain what he would plant in the health-insurance garden instead. Otherwise his assurances on the future have little credibility. He earns Three Pinocchios.

Three Pinocchios

 


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