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Bill Straub: Kentucky GOP’s rendition of ‘I’m Against It’ may hit sour note on health care

At the outset of the still wonderful Horse Feathers, filmed in 1932, Groucho Marx as Professor Quincy Adams Wagstaff, the freshly anointed president of Huxley College, lets the faculty know precisely how he intends to run the campus by singing, “I’m Against It.”

Your proposition may be good,
But let’s have one thing understood,
Whatever it is, I’m against it.
And even when you’ve changed it or condensed it,
I’m against it.


That little ditty assumes new resonance, at least in Kentucky, as it relates to the Affordable Care Act, better known as Obamacare, which has succeeded in securing health care coverage for thousands of the commonwealth’s poorest citizens who couldn’t afford it by, among other means, expanding Medicaid.

According to the Gallup-Healthways Well-Being Index, Kentucky ranks second, only behind Arkansas, in reducing the rate of uninsured since the implementation of the massive health care reform measure. Gallup found that 20.4 percent of the state’s population didn’t carry health insurance in 2013. As of midyear 2014, that number had dropped to 11.9 percent.

Earlier this month, Gov. Steve Beshear announced that 521,000, almost 10 percent of the state’s residents, enrolled for health care coverage through Kynect, the online insurance marketplace created to help residents pick and choose their insurance coverage. An earlier estimate placed the number of those signing up who had no previous health care coverage at 75 percent. Of that total, one estimate placed the number of new enrollees under expanded Medicaid at more than 102,000 through June.

The number of uninsured Kentuckians has decreased in all of the state’s 120 counties since Kynect began open enrollment on Oct. 1, 2013. In Leslie, Perry and Letcher counties deep in the heart of Appalachia Kentucky, the uninsured rate fell from more than 20 percent before the ACA to less than 5 percent.

And while premiums are expected to increase, the hike is unlikely to reach onerous pre-Obamacare levels. The U.S. Department of Health and Human Services has warned insurers that their practices will come under close scrutiny should premiums increase more than 10 percent in one year. It’s expected most increases will be in the range of 8 to 9 percent and it won’t affect those on Medicaid.

Now that all sounds like pretty good news – more than a half-million Kentucky residents feel less financial pressure in the face of potential medical disaster. And Kentucky, along with Arkansas, is the poster boy for it all.

So, how is the state Republican establishment reacting to all the rainbows and chocolate bonbons?

They’re trying to kill it, of course.

I don’t know what they have to say,
It makes no difference anyway,
Whatever it is, I’m against it.
No matter what it is or who commenced it,
I’m against it.


On Tuesday of this week the Kentucky Republican Party, in an ongoing effort to claim the state House of Representatives, thus giving it a majority in both legislative chambers, issued what it called a “Handshake with Kentucky,’’ a legislative program intended to attract voter fealty. Included was a proposal to kill Medicaid expansion and obliterate all remnants of Obamacare without, of course, offering an alternative to those who have benefitted.

“Kentucky simply cannot afford the unprecedented expansion of our Medicaid system mandated through Obamacare and passed by the Washington Democrats,’’ the package said. “House Republicans are prepared to take action to do what we can to repeal this expansion before it plummets our state into crippling debt.  It is important that the voices of frustrated Kentuckians be heard on this issue.’’

Those voices have pretty much been heard. A poll conducted late in 2013 by the Policy Research Center at the University of Cincinnati for the Foundation for a Healthy Kentucky found that 79 percent of the 1,551 adults surveyed supported Beshear’s decision to expand the Medicaid rolls, indicating a lot of folks might view the GOP initiative as something more like what used to be called a New Jersey handshake – an extended hand followed by a swift knee to the groin.

Under Obamacare, Medicaid eligibility was expanded to include residents with incomes up to 138 percent of the federal poverty level. Washington usually picks up about 70 percent of the tab but is footing the entire bill for those newly eligible through 2016. Thereafter, the state will pay 3 percent in 2017, rising to a cap of 10 percent in 2020 – a good deal considering the anticipated reduction in unpaid hospital bills. Beshear, in fact, maintains the Medicare expansion will actually prove financially beneficial with an additional $800 million coming the state’s way into the 2020s, rendering GOP claims indefensible.

Legislative Republicans aren’t alone in harping on the Kentucky success. The entire congressional delegation save for the lone Democrat, Rep. John Yarmuth, of Louisville, want to repeal most if not all the measure, sometimes making wild claims about it – Sen. Rand Paul, of Bowling Green, at one point claimed “for every Kentuckian that has enrolled in Obamacare, 40 have been dropped from their coverage,’’ a mathematical impossibility.

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Paul, during an appearance on This Week late last year, also expressed concern that the Medicaid expansion might not only prove too costly but that “in my state, we have a lot of rural hospitals that teeter in the balance. My fear is that these hospitals may be bankrupt by overwhelming them with Medicaid patients.’’

But the Affordable Care Act contains provisions to cover its costs, including $741 billion in spending cuts and a few small taxes, plus additional revenue, another $318 billion, realized as a result of expanding insurance and reductions in uncompensated medical care.

And it’s expected that rural hospitals will benefit in states like Kentucky that have embraced Medicaid expansion while states that reject the offer – thus turning their backs on billions of dollars in revenue – will suffer. The law was written to reduce the number of uninsured people that small rural hospitals are required to serve. Expanding Medicaid is expected to pick up much of those costs.

An easy comparison can be made between the Bluegrass and every Kentuckian’s favorite state, Tennessee. While Kentucky established its own health care exchange and eagerly embraced the Medicaid expansion, Tennessee said nix to both, relying on the federal exchange to drum up business.

While Kentucky has seen its uninsured residents drop by 8.5 percent, Tennessee has realized only a 2.4 percent reduction. Kentucky now has a smaller percentage of uninsured – 11.9 percent – than Tennessee – 14.4 percent. According to the most recent figures released by the Centers for Medicare and Medicaid Services, Kentucky has experienced 16.8 percent increase in Medicaid enrollees from the pre-open enrollment period through June, going from 606,805 to 708,808. Tennessee, during the same period, experienced a 7.2 percent increase, from 1,244,516 to 1,334,403.

And while rural hospitals aren’t exactly flourishing in Kentucky, health care providers did receive $284 million from the Medicaid program during the first quarter of 2014 — $135 million going to hospitals — with more in the pipeline. In Tennessee, several rural hospitals face closure. The Haywood Park Community Hospital in Brownsville shut its doors on July 1.

“The Tennessee Hospital Association warned that rural hospitals would close if Tennessee did not expand its Medicaid program.” Association President Craig Becker told The Tennessean, of Nashville, last December. “The vast majority of our hospitals that are financially distressed right now are in our rural areas.”

Nationally, most Americans remain opposed to the Affordable Care Act even though the measure is meeting, perhaps exceeding, its goals. Some action was necessary. In 2008, 14.8 percent of the population didn’t have any form of health insurance. By the third quarter of 2013 it had risen to 18 percent.

Under Obamacare the total has nosedived to 13.4 percent. States like Kentucky that have embraced Medicaid expansion and developed their own health exchanges are experiencing a substantially larger drop in the uninsured rate than states that retained the status quo.

Groucho being against everything is funny. Republicans, especially when it affects Kentuckians’ health care? Not so much.

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KyForward Washington correspondent Bill Straub served 11 years as the Frankfort Bureau chief for The Kentucky Post. He also is the former White House/political correspondent for Scripps Howard News Service. He currently resides in Silver Spring, Maryland, and writes frequently about the federal government and politics.

To read more from Bill Straub, click here.

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