How to Run Against Obamacare in a State that Depends on Obamacare

As Republicans look to take the governor’s mansion in Kentucky, they’ll have to contend with the law’s success in connecting residents with insurance.

WASHINGTON, DC - MARCH 27: Sisters and Tea Party members of Atlanta, Georgia, Judy Burel (L) and Janis Haddon (R), protest the Obamacare in front of the U.S. Supreme Court March 27, 2012 in Washington, DC. The Supreme Court continued to hear oral arguments on the Patient Protection and Affordable Care Act. (Photo by Alex Wong/Getty Images)
Karyn Bruggeman
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Karyn Bruggeman
Feb. 9, 2015, 3 p.m.

Re­pub­lic­ans love run­ning against Obama­care, and in the half-dec­ade since the law passed, they’ve rid­den that strategy to a host of con­gres­sion­al and gubernat­ori­al vic­tor­ies. They’ve been par­tic­u­larly suc­cess­ful in lever­aging the law to oust mod­er­ate Demo­crats from purple states. In that re­gard, as Ken­tucky Re­pub­lic­ans hope to re­take the Gov­ernor’s Man­sion this Novem­ber, the anti-Obama­care cam­paign strategy ap­pears ideal. But in Ken­tucky, it’s not so simple, be­cause in Ken­tucky, the law has had tre­mend­ous suc­cess in get­ting state res­id­ents in­sured.

More than half a mil­lion Ken­tucki­ans signed up for private in­sur­ance or Medi­caid through the state’s Obama­care ex­change. Since the ex­change — known as “Kynect” — launched in 2013, the state has cut its un­in­sured rate by more than 40 per­cent. And be­cause Ken­tucky, un­like many red and purple states, set up its own ex­change, the state’s as­pir­ing in­sur­ance buy­ers were spared the early fail­ures of Health­Care.gov. In exit polling from the 2014 Sen­ate race, 50 per­cent of voters said Kynect was func­tion­ing “well” or “very well,” com­pared with 37 per­cent who as­sessed the ex­change neg­at­ively.

The ex­change’s pop­ular­ity, however, didn’t stop Re­pub­lic­an Sen. Mitch Mc­Con­nell from at­tack­ing Obama­care en route to a massive vic­tory last year over Demo­crat Al­is­on Lun­der­gan Grimes. Mc­Con­nell, who has pushed re­lent­lessly for re­peal of the law, as the top Re­pub­lic­an in the Sen­ate, ad­ded a Ken­tucky twist for his state race: He at­tacked Obama­care as a whole, but said Kynect could sur­vive even if the fed­er­al law came off the books. (The claim was chal­lenged by Demo­crats, who noted that the ex­change de­pends in part on Obama­care sub­sidies and man­dates.)

It’s un­clear, however, wheth­er a Re­pub­lic­an gubernat­ori­al can­did­ate will ap­ply the same strategy, or if that rhet­or­ic­al line will sur­vive the party’s com­pet­it­ive four-way primary. Both the over­all law and Kynect are un­pop­u­lar among Re­pub­lic­an voters, and the race’s two un­der­dogs have already pledged to scrap the ex­change en­tirely. And therein lies the dif­fi­culty for the two fa­vor­ites. If they coddle Kynect in the primary, they risk los­ing the base and watch­ing the gen­er­al elec­tion from the couch. But if they pledge to do away with the ex­change, they risk drift­ing too far to the right of the state’s swing voters — and hand­ing a health care ad­vance to the state’s Demo­crat­ic can­did­ate, At­tor­ney Gen­er­al Jack Con­way.

So far, the two GOP front-run­ners — state Ag­ri­cul­ture Com­mis­sion­er James Comer and former Louis­ville Metro Coun­cil mem­ber Hal Hein­er — have been tight-lipped over what they would do with Kynect.

Hein­er’s cam­paign was re­luct­ant to of­fer much by way of com­ment on the top­ic. Spokes­man Doug Al­ex­an­der would say only this: “Hal Hein­er op­posed Obama­care from its in­cep­tion, and sup­ports ef­forts by Sen­at­ors Mc­Con­nell and [Rand] Paul to re­peal the law.” Al­ex­an­der wouldn’t re­spond to ad­di­tion­al ques­tions on wheth­er Hein­er agreed with Mc­Con­nell’s state­ment that Kynect could per­sist even ab­sent Obama­care.

In a state­ment provided to Na­tion­al Journ­al, Comer de­scribed Kynect as “just a tool to ex­pand Medi­caid.” In­deed, 80 per­cent of people who got in­sur­ance through Kynect did so by en­rolling in Medi­caid. (Ken­tucky’s ex­change is one of the few in which the in­sur­ance ex­change’s only portal can also be used to con­nect with Medi­caid.) But in­stead of re­peal­ing the pro­gram, Comer says he would call for re­forms, in­clud­ing a pro­pos­al “that Ken­tucky re­quires Medi­caid par­ti­cipants to reen­roll in Medi­caid every two years like every­one with private health in­sur­ance plans have to do.”

Former Ken­tucky Su­preme Court Justice Will Scott and Mc­Con­nell’s 2014 primary chal­lenger, Matt Bev­in, mean­while, have been un­equi­voc­al. Bev­in and Scott are call­ing for an end to the Kynect ex­change and the trans­fer of the pro­gram’s private in­sur­ance en­rollees to the fed­er­al ex­change. Scott’s lo­gic is this: “The only thing we are get­ting out of a state-run Obama­care ex­change is the priv­ilege of pay­ing for it. When we shut ours down, the feds will come in and pay for the whole thing.”

Ac­cord­ing to a spokes­per­son at the Ken­tucky Cab­in­et for Health and Fam­ily Ser­vices, Kynect cur­rently costs the state roughly $28 mil­lion a year to ad­min­is­ter. States were giv­en fed­er­al funds to set up their ex­changes, but they are now re­spons­ible for the costs of ad­min­is­ter­ing them.

Not­ably, no Re­pub­lic­an in the race has yet called for a re­peal of Medi­caid ex­pan­sion, sym­bol­iz­ing the lim­its of run­ning against a law that’s be­come in­creas­ingly in­grained. “If we start fol­low­ing the law, we’re stuck fol­low­ing the law. The apt ana­logy is a roach motel — you can check in, but you can’t check out,” Dav­id Adams, Scott’s cam­paign man­ager, said of the dif­fi­culties of tak­ing back Medi­caid ex­pan­sion.

The ques­tion of Kynect’s fu­ture is un­likely to go away be­fore Novem­ber. In the primary, it is one of the few is­sues that di­vides the GOP field, giv­ing Scott and Bev­in an in­cent­ive to ac­cen­tu­ate it as they try to make up ground. And, in the gen­er­al, it prom­ises to be a key is­sue: Ques­tions about Mc­Con­nell’s view on Kynect were largely hy­po­thet­ic­al — sen­at­ors don’t get a say over their state’s ex­changes — but after the Novem­ber elec­tion, the fate of the state’s ex­change will rest largely in the new gov­ernor’s hands.

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