Extremist Republican Matt Bevin first made waves in a primary against Kentucky Sen. Mitch McConnell last year by running far to McConnell's right. Among his promises: Obamacare repeal. That was also one of his messages in this governor's race. Back in February, he
said he would "absolutely" end Medicaid expansion. "No question about it," he said. "I would reverse that immediately." But the reality is that more than 400,000 people would be kicked off of Medicaid. Additionally, the state is under contract with the federal government to keep the Medicaid expansion, and Kentucky's version of it—known as Kynect—is pretty popular in the state. So in recent months, Bevin has
softened that stance.
"I plan to use the open enrollment period in 2016 to transition people from the state-level exchange to the federal exchange," Bevin told the Cincinnati Enquirer last week. "Once all are transitioned, I would shut down the exchange." When it came to Medicaid, Bevin pledged to "repeal the expansion as it currently exists, and seek a Section 1115 waiver from the Center for Medicaid Services."
Here's the reality: Transitioning Kynect to the federal exchange would be purely symbolic. It would not change the status of anyone getting their health insurance through an Obamacare exchange. Kynect would cease to exist, which would of course make it lose its popularity, but that's about all. The Medicaid expansion issue is a little more complicated, and where the jeopardy lies. But, again, in saying that he would repeal it entirely, Bevin was over-promising and it seems that as the election got closer he realized that and backed down a bit, saying he would repeal it "as it currently exists." What does that mean? You can get a
preview in Arkansas, where new Republican Gov. Asa Hutchinson did pretty much that.
An 1115 waiver could allow him to pursue stuff like small premiums or co-pays for some beneficiaries, or work referral or wellness programs (though there are limits to what the feds will allow). But if Bevin wants to avoid kicking the hundreds of thousands covered by Medicaid expansion "to the curb," his version of "repeal" would add these wrinkles but keep the coverage expansion in place. Which is precisely what we're seeing right now in Arkansas, the one Medicaid expansion state prior to Kentucky last night that has had anti-Obamacare Republicans sweep into power.
Kentucky is under contract with the federal government to provide expanded Medicaid. He can't just renege on that contract, and can't necessarily make a change before 2017, when the feds cut the 100 percent funding they are providing back to 90 percent. Tea partier Bevin is facing the reality of repeal that Republicans have faced nationally: Undoing this law is just not that simple, and really unlikely to be all that popular.
