Health care is expected to figure prominently in races across the country, but perhaps nowhere will it resonate more than in a congressional district in Kentucky, where the issue has been the object of razor-sharp focus for much of the past decade.
A recent move by Republican Gov. Matt Bevin to drastically cut benefits to hundreds of thousands of Medicaid beneficiaries could feed the growing fury over Republicans’ handling of health care just months before voters hit the ballot box.
With President Trump’s unpopular health care overhaul plan—which left even Kentucky conservatives disappointed—already threatening GOP Rep. Andy Barr’s prospects, the controversial cuts add another weapon to Democratic challenger Amy McGrath’s armory.
McGrath told National Journal that frustrations with health care cut across the political spectrum in the district, and though the grassroots initiatives on health care remain largely nonpartisan, it’s clear that they align with her campaign’s fight for affordable coverage. While the campaign doesn’t plan to specifically message on the Medicaid cuts, she said the issue will only build desire for a change of leadership.
“The fundamental difference: I don’t believe you should be taking health care away from people,” she said. “These are our neighbors.”
The contentious and long-simmering battle over the Medicaid expansion boiled over once again at the start of July. Within days of a federal court ruling blocking the state’s federal waiver to institute stringent work requirements, Bevin swiftly cut a number of benefits for the roughly 460,000 Kentuckians who had gained coverage under the state’s 2014 program expansion.
The 6th District is probably unique in the state for its demographic range, possessing a well-off urban core as well as impoverished rural counties, said Dustin Pugel, a policy analyst with the think tank Kentucky Center for Economic Policy. In an analysis of state Medicaid data, the center found the majority of counties making up the district saw a double-digit percentage of their population lose coverage with the cuts.
A lifelong resident of the district, Pugel said such a move by Bevin was not unexpected, but that the sudden announcement of cuts sparked widespread confusion and outrage, including in the 6th, as a large number of beneficiaries abruptly lost access to dental and vision coverage. It also caused numerous providers to cancel medical appointments—sometimes incorrectly—en masse in the week that followed, he said.
In an interview with the Associated Press about the cuts, Barr said, “I have no reaction. It’s a state decision and I’m a federal lawmaker.” Though states chiefly administer the Medicaid dollars they receive from D.C., Congress retains the overriding power to shape, regulate, and fund state programs through federal legislation.
The Barr campaign did not respond to requests for comment.
While intricate policy debates rarely alter voter behavior, voters will turn out to assign blame once those policies become personal, said Steve Voss, a political scientist at the University of Kentucky. And much like the frustration over skyrocketing premiums, which primarily affected a small group, the impact of Medicaid cuts can multiply beyond those directly hurt and mobilize those who know them, he said.
“It’s more like parents in the front seat hearing about what the kids are arguing in back. It’s like, ‘Both of you shut up or I’mma swat you!’” Voss said, with a laugh. “If you want to talk about how this sort of issue would really take root and carry through to affect an election, it’s got to be that personal experience.”
“That kind of anger, that personal anger, carries over for months and months,” he added.
Health care battles in Kentucky have been so salient for years that they may have sensitized voters to the specific issues, said Jamila Michener, an assistant professor at Cornell University who studies the intersection of Medicaid and political participation.
Michener said the core of her research on Medicaid expansion found that it increased political participation across the board—energizing both those in favor of expansion and those against it. But she said that in her recent study that is pending publication, she found that people disengaged from the political process altogether in response to sudden and sharp Medicaid cuts.
“Having things taken away, especially suddenly and in ways that seem arbitrary, for people in Kentucky—that isn’t the kind of government you want to engage,” she said. “It’s the kind of government that isn’t even worth engaging because they don’t care about you.”
But the prominence of health care in Kentucky is unique, she said, and she’s closely watching to see the effect that wide-scale grassroots organizing efforts will have. And though Barr may believe voters won’t hold him accountable for actions by the state’s Republican governor, Michener said, Medicaid beneficiaries thoroughly understand the role that both state and federal politicians play in how they get their benefits. If they turn out to vote, beneficiaries likely won’t limit their frustration to just the governor’s race next year, she said.
On the other hand, Kentucky-based GOP consultant Scott Jennings said he Medicaid issue in the state has been so prominent for years that it’s too baked-in to be decisive in the 6th.
Jennings agreed with Barr’s position, noting it wouldn’t make sense for either candidate to message on the Medicaid cuts while running for federal office. If anything, he said, the issue could benefit Barr as the work requirements at the heart of the state’s waiver proposal are popular in Kentucky—and it would allow Barr to remind voters how much they hate Obamacare.
“Every cycle, Democrats rattle about how it’s going to be the defining issue,” he said. “Never really works out for them.”