When people called Greg Stumbo to talk "Obamacare," it was usually to say they were against it. The Democratic speaker of the Kentucky House of Representatives knew just what to say. President Obama had nothing to do with their health care, not really. They were eligible to find insurance on KYnect, the exchange created by popular outgoing Gov. Steve Beshear (D-Ky.).
"I'd tell em we’ve got Beshearcare,"said Stumbo in an interview Tuesday night, "and they’d be fine with that."
The disconnect between Obamacare and KYnect was one of the great paradoxes of American politics. In polls, Kentucky voters rejected Obamacare at roughly the rate they rejected the president, 2-1. But they were fond of KYnect, which Beshear created by executive order, bypassing a gridlocked Kentucky legislature. Month by month, Kentuckians took advantage of the state's Medicaid expansion or the plans offered on the exchange, and the state's uninsured rate plummeted from 20.4 percent to 9 percent. Beshear predicted that "the Democratic nominee will make this a major issue and will pound the Republicans into the dust with it.”
On Tuesday night, it was the Democrats eating dust. Attorney General Jack Conway, who was expected to replace Beshear, lost in a rout to Tea Party activist Matt Bevin. Conway defended KYnect; Bevin called it a disaster. While his prescription for changing it shifted, he ended the race with a promise to undo Kentucky's successful experiment.
"I plan to use the open enrollment period in 2016 to transition people from the state-level exchange to the federal exchange," Bevin told the Cincinnati Enquirer last week. "Once all are transitioned, I would shut down the exchange." When it came to Medicaid, Bevin pledged to "repeal the expansion as it currently exists, and seek a Section 1115 waiver from the Center for Medicaid Services."
Bevin's win, and the Republican victories in neighboring Virginia, were body blows to Democratic hopes of enforcing the Affordable Care Act. Virginia voters rejected a chance to hand the state Senate back to a party that would expand Medicaid; some Kentucky voters who had benefited from the expansion surely voted against the candidate who'd keep it as is. Bevin pulled some of his best numbers in Kentucky's impoverished eastern counties, where enrollment had been highest. As the polls closed, the situation reminded author Thomas Frank of his thesis in "What's the Matter With Kansas?" of voters striking out against their interests.
"It's a classic example, up there with fighting over the theory of evolution," said Frank.
Winning over voters with expanded health care access was not supposed to be this hard. Beshear wasn't the only Democrat who talked about it. In 2009, as the Affordable Care Act debate burned through Washington, former President Bill Clinton told progressive activists that passing a bill would come with political benefits.
"The minute the president signs a health care reform bill his approval will go up," he said. "Secondly, within a year, when all those bad things they say will happen don't happen, and all the good things happen, approval will explode."
That did not happen, even in a red state where a Democratic governor ran an ideal version of the ACA expansion. On Tuesday night, a shocked Stumbo was girding for a fight with his slim majority on one side and Republican governor and anti-ACA groups like Americans for Prosperity on the other. AFP had marched through much bluer states, and broken the support for the ACA, halting the Medicaid expansion and the construction of KYnect-style exchanges. Some states had botched the exchanges and handed control to the feds. But no state had rolled back the programs, as Bevin seemed ready to do.
"I’m gonna fight for KYnect because I believe it would be inhumane to take health insurance away from hundreds of thousands of people," Stumbo said. "The problem is that we never statutorily approved it. It’s gonna be a battle in this next session to see what happens with that program. Everybody: Put on your boots and your big-boy pants."