By Cheyene Miller
University of Kentucky School of Journalism and Telecommunications
The U.S. Senate race between Republican Sen. Mitch McConnell and Democrat Alison Lundergan Grimes has seen the candidates focus on several key issues, including the coal industry, the minimum wage and health care.
The health-care issue has been almost unique among Senate races in that Kentucky is generally seen as a success story for the Patient Protection and Affordable Care Act. In August, Gov. Steve Beshear said 521,000 of Kentucky’s 4.3 million citizens had signed up for health coverage through Kynect, the state’s health insurance marketplace created under the law.
According to a Gallup-Healthways poll, published in August, Kentucky reduced its percentage of uninsured more than any other state besides Arkansas, and lowered the percentage of uninsured in the state from 20.4 percent to 11.9 percent, thus covering two of every five uninsured Kentuckians.
In addition to funding the expansion of Medicaid, the law requires Americans to either purchase private health insurance or enroll in some form of government assisted health care like Medicaid; requires insurance companies to cover people with pre-existing conditions and provide 10 elements of coverage in each policy; allows parents to keep their children on their health insurance until they are 26; and requires businesses employing 50 or more full time employees to provide health insurance, a provision that President Obama has suspended for a year.
McConnell says he wants to repeal the law “root and branch,” but has been more lenient toward the idea of keeping Kynect. In the Senate race debate on KET, McConnell suggested that Kynect was merely a website. However, repealing the law could pose issues for the newly insured in Kentucky because private insurance under Kynect uses federal tax credits, and provides free Medicaid coverage to citizens who earn up to 138 percent of the federal poverty level.
According to Douglas McSwain, a Lexington-based litigation attorney who specializes in constitutional and health-care law, the uprooting of the law would result in drastic changes to Kynect.
McSwain said repealing the ACA “root and branch” would mean cutting the federal tax subsidies that are essential to Kynect’s survival.
“You take the exchange tax credit away, do you think for a minute that the website is going to stand?” McSwain asked. “Nobody is going to buy policies.”
At a Kentucky Farm Bureau forum in August McConnell said Congress should have passed laws allowing health insurance to be sold across state lines, limiting malpractice lawsuits and making it easier for businesses to form health-insurance groups.
McSwain said the law allows formation of such groups, and interstate regulation “is conceivable” but “The problem is we don’t have the infrastructure, regulatory-wise, to do that without having reached a compact or an agreement” among the states.
A study on the effects of malpractice reform, published by the New England Journal of Medicine, found that Texas, Georgia and South Carolina did not see a significant reduction in the amount of doctor-ordered tests and scans after enacting reforms. A five-person team of doctors performed the study, collecting data from 1997 through 2011.
Grimes has only publicly discussed health reform on select occasions, taking a similar strategy to many Democrats in the 2014 midterm election because of the unpopularity of “Obamacare” and its namesake. When she does mention health care, she talks about fixing and streamlining the law, as she did during the KET debate.
“I will not be a senator that rips that insurance from their hand,” Grimes said in reference to the half a million Kentuckians who’ve gained coverage under Kynect. She said McConnell was in a “fictional fantasyland.”
Grimes has also talked about supporting an extension of Obama’s “grandfathering” of insurance policies that don’t comply with the law after he was criticized for not keeping his campaign promise that Americans could keep their doctor and health plan if they liked them.
That controversy and other aspects of the law have led to negative feelings among Kentuckians about Obamacare. A poll by Marist College for NBC News showed Obamacare had a 33 percent approval and 57 percent disapproval rating among Kentuckians, while Kynect had 29 percent approval and a 22 percent disapproval., while 29 percent of those polled said that they had never heard of Kynect and 21 percent were unsure of how to rate it.
At last report, about 80,000 Kentuckians had bought private insurance through Kynect and about 440,000 had used it to get on Medicaid – 320,000 of whom were eligible under the new rules and 120,000 under the what state officials call “old Medicaid.” The federal government pays about 71 percent of “old Medicaid” costs and, until the end of 2016, 100 percent of the newly eligibles’ coverage. In 2017, it will pay 95 percent of the new costs, and fall to the reform law's floor of 90 percent in 2020.
Cheyene Miller of London, Ky., wrote this story for “Covering the U.S. Senate Race,” a special course in the University of Kentucky School of Journalism and Telecommunications.