Gov. Steve Beshear's support puts him at odds with the state's U.S. senators. Kentucky's embrace of Obamacare

LOUISVILLE, Ky. — Mitch McConnell can’t say often enough how much he opposes Obamacare. But as the Senate’s top Republican begins his reelection campaign, the Democratic leaders of his home state are embracing the controversial health law and its ambitious goals more aggressively than any of their southern neighbors.

For Kentucky Gov. Steve Beshear, who is term-limited and can’t run again in 2015, making the law work is a top priority. He believes it can improve the chronically poor health status in his state and cover up to 640,000 uninsured residents.


Beshear’s all-out support for President Barack Obama’s health care reform law puts him starkly at odds with Kentucky’s senators — McConnell and Rand Paul — who argue that neither the country nor the state can afford a new entitlement program that they say has already raised premiums and kicked people off their existing plans.

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The tension among Kentucky’s leaders was on very public display last week at the 50th annual Kentucky Country Ham Breakfast and Auction, which brings together the state’s politicians to honor the farm industry and raise money for charity by bidding on a ham.

As McConnell and Paul sat just a few feet away, Beshear touted the many benefits of the health law. McConnell smirked as Beshear called for quelling the repeal efforts.

“It’s time for our leaders, all of our leaders — at the local, state and national levels — to put aside this time-worn political posturings that you’re doing all the time and start working for the people,” said Beshear, who unsuccessfully tried to unseat McConnell in the 1996 Senate race.

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Kentucky is the only southern state to set up its own health insurance exchange. Beshear signed an executive order to create it a year ago despite Republican opposition in the Legislature. The other southern governors have left all or part of the exchanges to the federal government. Beshear followed up earlier this year with plans to expand Medicaid to cover poor adults, which most nearby states are shunning.

Kentucky doesn’t fit the mold of the states aggressively implementing the Affordable Care Act. Most others, such as California, Vermont, Connecticut and Oregon, are more liberal states with a record of progressive social and health policy. Nor has Kentucky been a particularly high-profile innovator among states looking at new ways of delivering care or advancing public health.

But advocates see a dramatic need for better health care here: The Bluegrass State leads the country in cancer deaths, preventable hospitalizations and smoking, and it is ranked among the worst in several other categories.

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“Every single Kentuckian will have access to affordable health insurance — that’s never happened before,” Beshear told POLITICO. “And in a generation that will make a huge change in the quality of life in our state.”

The state will be ready for open enrollment on Oct. 1, he said. In fact, it may be the first state to be officially declared ready by the federal government. “We’re working very hard to do that,” he said.

Conservatives are pressing McConnell, who is up for reelection next year, to take a more active stance against Obamacare. National tea party leaders went to Kentucky this week to kick off their “Exempt America” tour. They hope to pressure McConnell to join a group of Republicans who want to defund Obamacare, even if that means shutting down the government this fall.

McConnell, in his own appearance at the state fair breakfast, said people are right to worry. He said the law is already hurting the state, citing a decision by UPS — one of Kentucky’s largest employers — to drop coverage for some employee spouses who can get coverage through their own jobs.

“So, governor, the solution to Obamacare is to pull it out root and branch,” he said.

McConnell’s spokesman, John Ashbrook, said the senator has held 50 town hall meetings at hospitals in the state and has heard from countless other people in Kentucky.

“They’re saying that Obamacare is a disaster that looks nothing like what was promised; it raises costs, raids Medicare and kicks people off of their current plans,” Ashbrook said. “It’s only going to get worse, which is why Sen. McConnell is fighting so hard to repeal it and replace it with common-sense alternatives that actually fix the cost problem.”

Paul told reporters at the country ham breakfast that he questions where the Obama administration is coming up with the money for a new entitlement program.

“They have no money in Washington,” he said. “Ultimately, it’s going to bankrupt our state because the federal government pays the bills for a couple years, then the bills kick in and they’re going to need to be paid for in Frankfort, and there’s not going to be enough money.”

Beshear accused McConnell and Sen. Rand Paul of “playing politics” and said their opposition to the law is only because it’s called Obamacare.

“If this had been called Romneycare — which you could call it that because it’s the same kind of plan that Gov. [Mitt] Romney put in in Massachusetts — and it’s working up there,” he told POLITICO after the breakfast. “They didn’t talk about 640,000 uninsured Kentuckians. They just want to rail and rant against President Obama.”

The state government has been running television ads touting the exchange, which Kentucky has dubbed Kynect, since early this summer. It has set up booths at baseball games, craft fairs and even the Kentucky State Fair, where volunteers gave out 20,000 tote bags loaded with exchange information over 11 days earlier this month.

Kentucky is expected to spend $252 million on implementation of the law through 2015, according to state officials. The health reform budget includes $11 million on advertising and outreach.

The effort so far appears to be paying off. HHS chose to start its final round of IT tests in Kentucky last week.

“We are encouraged by Kentucky’s work to pass Medicaid expansion, set up a marketplace and engage in a robust outreach and education effort that is tailored to the state,” HHS spokeswoman Joanne Peters said. “We’re pleased to have strong partners on the ground in Kentucky who are committed to ensuring all Kentuckians have access to quality, affordable health coverage.”

Beshear said that’s why he’s going big on Obamacare.

“We’ve got to do something different,” Beshear said outside of the State Fair last week. “This Affordable Care Act gives us that opportunity. It gives me the opportunity by making some decisions now, to make sure future generations of Kentucky are much more healthy than they are right now.”

Beshear said carrying out the law was a no-brainer once he saw economic analysis that said the Medicaid expansion alone would bring $15.6 billion to the state and create nearly 17,000 jobs in eight years.

“We don’t want the federal government running our exchange — no offense to them, I’m sure they’ll do a perfectly nice job in other states, but we wanted to be in charge of our own destiny,” said Audrey Haynes, secretary of the Cabinet for Health and Family Services.

In fact, state control of the exchanges was what the congressional authors of the law initially expected; the decision by conservative governors to basically walk away created a host of unanticipated obstacles, both practical and political.

But even in Kentucky, substantial questions remain. The state has not announced the prices for insurance plans on the exchange even though there are only a few weeks until people can start signing up for coverage that will kick in on Jan. 1.

At the Kynect booth at the state fair, many visitors recognized the name but knew little about the program or what it would mean for them. Some feared it would do more harm than good.

“It scares me. Obamacare scares me for all those people who are going to have to wait in line to have the things they need done,” Tanya Harris, a Louisville resident, told POLITICO after grabbing one of the Kynect totebags.

“People are afraid of things they don’t understand,” Harris said, “and until I can understand it better, I am afraid of it.”