Kentucky is feeling the first waves of panic now that tea party Republican Matt Bevin is about to become governor and implement his plans for undoing Kynect, the state's Obamacare program. While it's not entirely clear what those plans are now, since he's backtracked on his original full-on repeal position, he's still making it a top priority. In his first news conference, Bevin said the dismantling would be done in "a thoughtful way," hinting that he wouldn't dump everyone who now has coverage through it off of the rolls. That's slim comfort now for people who might lose coverage—even those who voted for him.
Still, the broad contours of his condemnation of the ACA are creating a quandary here in remote Pike County, where 55 percent of voters supported Bevin even though the county benefits greatly from the health-care changes he plans to rescind.
Dennis Blackburn has this splintered self-interest. The 56-year-old mechanic hasn't worked in 18 months, since he lost his job at a tire company that supplies a diminishing number of local coal mines. "The old guy had to go home," Blackburn says of his layoff. […]
On Election Day, Blackburn voted for Bevin because he is tired of career politicians and thought a businessman would be more apt to create the jobs that Pike County so needs. Yet when it comes to the state's expansion of health insurance, "it doesn't look to me as if he understands," Blackburn said. "Without this little bit of help these people are giving me, I could probably die.... It's not right to not understand something but want to stamp it out."
Pike County accounts for a remarkable 7,500 of the new Medicaid enrollees, Blackburn included. The uninsured rate there dropped from 13 percent in 2013 to 6.6 percent in 2014. Bevin can't undo all that immediately, even if he decides that's what he really wants to do. He has to give one year's notice to shut down the state's exchange and move everyone onto Healthcare.gov, the federal system. Even if he does make that change, the outcome for enrollees in those private plans probably won't be too dire. And he'll have hard work in creating a Medicaid plan that the federal government will approve. He's hamstrung by state law that requires the state take as much Medicaid funding as is available to it. And before he can ditch Medicaid expansion, he'll have to repeal that law, or risk lawsuits if he ignores it. Those are his political challenges.
Here's the political challenge for the state's Democrats: Understanding why people like Dennis Blackburn voted against their interests, and for Bevin. Clearly, Medicaid is a key issue for Blackburn and he's worried. But the Democrat, Jack Conway, didn't run on the issue, instead focusing on Bevin's tax problems. He didn't run on policy. He didn't give all those 400,000 new Medicaid recipients a compelling reason to vote, and vote for him. That was a disservice to his own campaign, to the Democrats’ down ticket, and to the people of Kentucky.