In the Red state that beat Obama at enacting a very blue law, it's healthcare that's most closely watched.
The potential loss of a long-time Republican Senate seat to a Democrat in a mostly Red state is of national interest, but it should be even more of interest to those of us in healthcare, because healthcare reform — and the politics surrounding it — is one of the biggest issues at play in the race.
Political junkies are closely watching Congressional primaries across the country, and today all eyes are on the Senate GOP race in Kansas.
Yet, what I expect will be one of the most exciting Congressional races come November got a lot of press coverage over the weekend, as incumbent Senator Mitch McConnell (R-Ky.) and challenger Alison Grimes (a 35-year-old Democrat who currently serves as Kentucky's Secretary of the State) met at one of the state's most historic — and politically charged — events, the Fancy Farm church picnic in western Kentucky.
The potential loss of a long-time Republican senate seat to a Democrat in a mostly Red state is of national interest, but it should be even more of interest to those of us in healthcare because healthcare reform — and the politics surrounding it — is one of the biggest issues at play in the race.
Kentucky, a Red state which ranks as one of the top five unhealthiest states in America, launched its state-run marketplace, Kynect, last fall. Since then, "Kentucky has pulled in 521,000. That’s an astounding 82% of the state's uninsured population, a percentage far above the national totals," wrote journalist Steven Brill in a recent TIME
Why Al Sharpton says Minority Leader Mitch McConnell is in "the fight of his political life": http://t.co/VC4j3wF0Pd pic.twitter.com/A6S98W2zs1
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(You may remember Brill for his 2013 TIME article, "Bitter Pill: Why Medical Bills are Killing Us." The article brought national attention to the large variation and mark-up within medical bills across the country. After it, CMS to released data on the 100 most frequently billed inpatient charges and 30 most common outpatient charges, finding large variation in hospital prices from market to market. North Carolina and Arizona enacted laws requiring hospitals to post chargemaster prices of their most common procedures.)
But, back to Kentucky…
Don't call it Obamacare
The state successfully insured 82 percent of its previously uninsured residents through Medicaid expansion and the private plans offered on its marketplace — nothing short of a true success story.
Republican Governor Steve Beshear, who supported the state's marketplace development and Medicaid expansion, became the poster boy for the law, having succeeded where the feds did not.
But, unsurprisingly, many in his party criticized his decision to carry out reform. Still today, half of the state's residents want to repeal the law (perhaps not realizing their coverage, and subsidies, could go with it).
Yet, Beshear hasn't seemed to suffer. A recent Herald-Leader/WKYT poll gave him a 54 percent approval rating, and he's had one as high as 69 percent in the last four years.
Perhaps this is the reason why: He had the foresight to take Obama out of Obamacare before rolling it out to Kentuckians.
Residents of the Bluegrass State like Kynect, "the name Beshear smartly gave [the marketplace] in the run-up to the launch," writes Brill.
But ask them if they like Obamacare, and their story changes: "Polls consistently report that voters in Kentucky approve of Kynect, even if they voice disapproval when asked about Obamacare. Again, Kynect is Obamacare."
The fact that Kentuckians like Obamacare in theory, but not Obama, or anything with his name on it, has led to a predicament for two Senate challengers, who are fighting one of the most closely watched Senate races in the country. Incumbent Sen. Mitch McConnell is a staunch opponent of the law and has called for its repeal. Four days after the state exchange's successful launch, Sen. McConnell joined with Sen. Rand Paul (R-Ky.) to attack the governor over the launch in a Kentucky-Inquirer op-ed (selected quotes taken from Brill's article):
"The governor likes to tout his so-called discounts for health insurance…What he won’t tell you is that most Kentuckians won’t receive them … As so often happens when our friends on the left set out to fix a problem, their ideas, however well-intentioned, end up hurting the very people they sought to help. That’s just what we’re seeing with Obamacare."
Yet, recently McConnell has quieted a bit on the anti-healthcare reform front. "McConnell— who is in a hard-fought race to retain his Senate seat — is no longer writing op-eds attacking the health-reform law. He's not talking much about it at all," writes Brill.
His attempts to separate himself from his dislike of the law hasn't gone so smoothly in recent months. At a news conference in May, he called the state exchange "disconnected" from Obamacare, causing the Washington Post to publish, "What did Mitch McConnell mean when he suggested the Kentucky state exchange was ‘unconnected’ to Obamacare?"
Brill gives more detail on the May gaffe:
"Responding to a reporter’s question about the apparent success and popularity of the law in his state, he said that while he still wanted Obamacare to be repealed, he saw no reason people getting their new coverage from Kynect would have to lose it.
When I asked McConnell campaign spokeswoman Allison More to clarify how people could keep Kynect if the subsidies and Medicaid expansion provided by Obamacare were repealed, she insisted that I put the questions in writing. I did, but I never heard back except to get a boilerplate statement a week later that McConnell “supports replacing it [Obamacare] with commonsense reforms that actually lower costs for patients."
While one might think Democrat challenger Allison Grimes has it easy as a supporter of the law, you'd be mistaken. "While Obamacare may not help McConnell or hurt Grimes, it is not likely to generate the same kind of partisan loyalty for Obama and Democrats generally that Medicare and Social Security did," writes Brill.
Remember, half the residents don't like Obamacare, despite liking Kynect. As such, Grimes has also had to distance herself from the Affordable Care Act, at least in its "Obamacare" form.
"Apparently sensitive to the popularity of the law among those benefiting from it but worried about supporting anything linked to Obama, she has said Obamacare should not be repealed and taken away from Kentuckians but that changes should be made. However, she hasn’t specified what those changes would be," writes Brill.
The narrative writes itself. A Red state. A Red governor, who did something very Blue, but is loved for it. A Red senator, the 4th-longest serving Republican in the senate, who doesn't quite know how to handle the fact he supported a law, the impact of which most of his residents like. A shiny, young blue challenger, who can't embrace the law too much or risk seeming just too blue.
It will be the race to watch in November, and I'll be glued to the news to see how their references to the Affordable Care Act and Obamacare change as the race draws nearer.
Perhaps the best political bet for both of them is to try to move the conversation away from healthcare and toward other hot issues in the state, like coal production and gun laws.
But then again, would anyone in Washington care? In the Red state that beat Obama at enacting a very blue law, it's healthcare that's interesting and most closely watched.