Supporters of the Patient Protection and Affordable Care Act are not happy with news out of Kentucky, which on Tuesday elected Matt Bevin, a Republican and vehement opponent of PPACA, as governor.
At the beginning of his tea party-themed campaign for office, Bevin promised to undo the Medicaid expansion that current governor Steve Beshear has undertaken as part of PPACA. According to the New York Times, Beshear's decision has extended coverage to an estimated 420,000 Kentuckians, or nearly 10 percent of the state's population.
However, as awareness has grown of the potential impact of such a radical change of course, Bevin changed his tune, saying that he would not throw off the hundreds of thousands who have gained coverage through Medicaid, but that he would limit the growth in enrollment.
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According to recent estimates, Kentucky has seen one of the greatest drops in its uninsured rate in the country since PPACA was implemented two years ago. Its chief competitor for the biggest drop is Arkansas, another conservative-leaning state in the South with a high level of poverty. According to a survey by Gallup, Kentucky's uninsured rate dropped from 20.4 percent to 9.8 percent after the first year of Obamacare, while Arkansas' dropped from 22.5 percent to 11.4 percent.
Both states had Democratic governors who accepted funds to expand Medicaid eligibility in their states for those with incomes up to 133 percent of the federal poverty level and who set up insurance exchanges that were at least partially state-run. While Kentucky's is entirely state-run, Arkansas entered a partnership with the federal government to operate its exchange.
While Healthcare.gov was bogged down by technical problems during the rollout of PPACA in late 2013, the website set up for the Kentucky exchange, Kynect, was held up as a model of success.
While the effect of the law appears to be largely positive throughout much of the poverty-stricken South, it is politically difficult for PPACA proponents to defend its merits in front of an electorate that often distrusts President Obama. When Greg Stumbo, the Democratic speaker of the Kentucky House of Representatives, defended the state marketplace to constituents, he referred to it as "Beshearcare," according to the Washington Post.
But the successes of PPACA were also overshadowed in recent weeks by the failure of a number of health insurance co-ops that were created by the law. The Kentucky Health Cooperative announced its impending closure earlier this month, forcing 51,000 to find new plans in 2016. Bevin seized on the co-op's failure as evidence that the law was not financially sustainable, and bashing his opponent, Attorney General Jack Conway, for expressing support for act.
"Even though it is a disaster for Kentucky taxpayers, Jack Conway still says he would have been proud to vote for Obamacare," Bevin said in a statement to Politico earlier this month.
It's unclear, given Bevin's shifting rhetoric on the issue, what he will do in office.
Understanding Kentucky's future might be understood by looking at Arkansas, which similarly had a pro-PPACA governor in power during the first year of the law's implementation, but then replaced him with Republican Asa Hutchinson, a committed Obamacare opponent. After decrying many aspects of the law during his campaign, Hutchinson decided to keep the Medicaid expansion in place while introducing certain "reforms" to the public health program by seeking federal waivers to impose certain cost-sharing measures on state Medicaid beneficiaries.
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