Republican Sen. Mitch McConnell, statistically tied with his Democratic opponent in one of the most closely watched Senate races in America, never misses an opportunity to blast “Obamacare”: on the hustings in his home state of Kentucky and on the floor of the US Senate, where he serves as the minority leader.
But Obamacare may not turn out to be the campaign issue that Senator McConnell hopes it will be. True, Kentuckians – like most Americans – disapprove of the Affordable Care Act. But they also live in a state where implementation of the ACA has been held up as a national model for its smooth rollout and easy interface with users. More than 1 in 10 residents is now covered by "kynect," the state-run exchange under the ACA.
Obamacare as a political issue will probably be "a wash," says Stephen Voss, associate professor of political science at the University of Kentucky in Lexington. Voters in the Bluegrass State sense that Obamacare is broken, he says, but they're open to the help that it represents – specifically through kynect.
This year, as McConnell urged the “repeal and replace” of Obamacare, Kentuckians flocked to the program that grew from it. More than 413,400 people were enrolled in kynect by mid-April. Surveys of enrollees show that 75 percent had no health insurance prior to kynect. And more than half of those signed up are under age 35 – far above the national average for this crucial age bracket.
While some GOP-led states shunned the ACA’s provision to expand Medicaid – health care for the poor – Kentucky’s popular Democratic governor, Steven Beshear, embraced it. Statewide, about 80 percent of kynect customers are covered by the Medicaid expansion, and the other 20 percent have chosen the exchange’s private plans.
Coverage for the poor is especially welcome here in Hazard, a town nestled in a region devastated by the recent collapse of the coal industry. In the past year, more than 10,000 jobs have been lost in eastern Kentucky, where unemployment now stands at 14.5 percent.
“I’m very appreciative” of kynect, says Stephen Kelly, who recently moved to Hazard on the promise of a job that then fizzled. The young man has a wife and two sons and a master’s degree in Christian ministry. After signing up in person for Medicaid under kynect, which he found to be a “convenient, simple” process, he underwent a physical and lab tests, which he had not had “in quite some time.” This is the first time he has had health insurance.
Mr. Kelly, who has since found a job in the local health-care industry, has mixed feelings about the ACA. While it is helping him and his family, he doesn’t like what it’s doing to others who already had insurance – such as his parents. His father, who lives in Harlan, Ky., is seeing his insurance costs skyrocket, Kelly says.
“Someone has to pay for this insurance; I’m not paying for it,” he reasons. “But I don’t want it to affect my country. I don’t want it to bankrupt us. I’m glad it’s there, though. I’m glad it’s there for people who need it.”
Some enrollees reacted emotionally to kynect, according to Charla Napier, chief operating officer of Primary Care Centers of Eastern Kentucky, which is administering the program in the area. During sign-up, she says, it wasn’t unusual to see people shed tears. For some, they were tears of relief for a health-care safety net. For others, they were tears of humiliation, as self-sufficient workers who used to have well-paying jobs and generous health insurance suddenly found themselves dependent on government assistance.
This helps explain the ambivalence of Kentuckians toward the ACA, seen in an April poll by The New York Times/Kaiser Family Foundation. People don’t like it, but they don’t want to scrap it, either. A majority – 55 percent – disapprove of the health-care law. But a majority also say their representative in Congress should work to improve the law, not repeal it and replace it with something else.
The poll had similar results in two other states with hotly contested Senate seats, Louisiana and North Carolina. And in Arkansas, another state with a close Senate race, a plurality – 48 percent – want Congress to fix, rather than repeal, the ACA.
Meanwhile, McConnell’s Democratic opponent, Kentucky Secretary of State Alison Lundergan Grimes, who favors the keep-and-fix approach, has avoided talking about the health-care law. Her supporters call kynect “Beshearcare,” after the governor.
But just wait until October, says state Sen. Robert Stivers (R). That’s just before the election – and when health insurance enrollment notices go out for the new year. People “are going to get sticker shock,” predicts Senator Stivers, president of the GOP-controlled Senate in the State Capitol.
If that comes to pass, McConnell may well benefit from his anti-ACA message. But until then, says Professor Voss, the new law “loses its power as an issue” because of the ambivalence about it.