Northern Kentucky debate (Photo by Albert Cesare, Cincinnati Enquirer)
By Al Cross
Kentucky Health News
Health-related issues figure prominently in some of the final messages that the candidates for governor are delivering to voters as Tuesday’s election approaches.
Democratic Attorney General Andy Beshear says of Republican Gov. Matt Bevin, “He has tried to rip health care away from our families.”
A Republican TV commercial says Beshear is “so liberal, he wants to give taxpayer-funded health care to people who can work and choose not to.”
And a Bevin TV ad says, “Beshear did profit from opioids” and “sold out Kentucky.”
The three commercials have varying degrees of truth, and as usual for political ads, fall far short of telling the whole story. They obscure a fundamental difference between the candidates on an issue that affects hundreds of thousands of Kentuckians.
That is the expansion of the federal-state Medicaid program by Beshear’s father, then-Gov. Steve Beshear. At last count, the expansion covered more than 450,000 people, paying their bills when they get health care.
Bevin wants to require as many as half of those people (estimates vary) to work, volunteer, attend school or take job training at least 80 hours a month, and make monthly reports, in order to keep their benefits. Those who are medically frail or must care for children would not be included.
Studies indicate that most Kentuckians who would be affected by the “community engagement” rules are already meeting them. One study based on polling found that 97 percent already meet the requirements; another, based on claims data, showed that 64% are.
A federal judge in Washington, D.C., has blocked Bevin’s plan, known as a waiver, and judges who heard an appeal last month sounded skeptical of it. Bevin has issued an order that would abolish the expansion six months after a final court decision against his plan. He has said the Supreme Court will decide the issue; the high court does not have to consider appeals.
The first version of Bevin’s plan estimated that after five years, the state’s Medicaid program would have 95,000 fewer people than it would without it—largely because of noncompliance, including lack of reporting. “This is paperwork and it is intended to tear health care away from people,” Beshear said in a debate, pledging to do away with the plan “in my first week of office.”
Bevin “has justified the idea both in terms of cost—because the state pays about 10% of the costs of the expansion—and values,” Idrees Kahloon of The Economist magazine writes in a “Democracy in America” column about the governor’s race after interviewing Bevin.
“When your correspondent asked him whether the point of the waiver was to save the state money, he flatly answered, ‘No,’ and then held up both his index fingers, one of which was more curved than the other, the result of having had to set it himself when he was young.”
“I have scars on my body that we couldn’t afford to get stitched up so they’re as thick as a finger instead of thin as a string,” Bevin told Kahloon. “Every dollar we give to an able-bodied, working-age person with no disabilities and no dependents is a dollar we’re not able to provide … for those truly in need in our state.” Bevin often says he has empathy for the uninsured because he didn’t have health insurance until he joined the Army.
Kahloon, a native of Morehead, notes, “Many of the counties in Kentucky most reliant on Medicaid—both for health coverage and to keep rural hospitals financially solvent—are also steadfastly Republican strongholds. To make inroads with them, Mr. Beshear must instill fear about the prospect of policy change. Whether he has done so is unclear.”
State House Minority Leader Rocky Adkins, who ran second in the May primary, talked about Medicaid as he campaigned last week with Beshear in Democratic counties in Eastern Kentucky. In that region, he said, “The only growth we’ve seen here has been in the health-care industry.” Bevin has discounted estimates of the Medicaid expansion’s creation of jobs.
There has been less debate about the Medicaid expansion than about Beshear’s record on the opioid epidemic. The Bevin ad’s contention that Beshear “did profit from opioids” and “sold out Kentucky” are based on Beshear’s partnership in the law firm of Stites & Harbison. It represented Purdue Pharma in the lawsuit filed against the maker of Oxycontin by then-Attorney General Greg Stumbo in the mid-2000s.
Stumbo’s successor, Jack Conway, settled the case for a $24 million payment by Purdue Pharma shortly before Beshear became attorney general. Beshear has said he took no part in the matter, but has refused to say whether he shared as a partner in the fees the law firm earned from Purdue. After Beshear took office, he approved a retroactive $4 million contract for work on the case by a Louisville firm that later made Conway a partner.
Beshear said in 2017 that he did not “recall doing any work” on the case at Stites & Harbison. “I was there a long time,” he said. “I don’t want to suggest that no one asked me a question about what General Conway was like or not like, but I was not an active participant in that case.”
This year Beshear wrote a memo that “says he stepped away from anything related to the state’s litigation against Purdue when he took office,” Phillip Bailey reports for the Louisville Courier Journal. “Why write that memo three years later? Beshear made multiple attempts to stiff-arm that question and others when I asked about the memo last week . . . Beshear said it was more appropriate to go through a campaign spokesman to schedule an interview, but he eventually relented.”
Beshear told Bailey, “We had a policy from the beginning that I was not involved in any Purdue matter other than making a recommendation about where the settlement funds went,” but wanted to document it because Purdue Pharma was rumored to be headed for bankruptcy.
Bevin’s chief of staff, Blake Brickman, told Bailey, “The memo only raises further questions. Any competent and ethical attorney knows that recusal letters are put in the record immediately, not over three years after the alleged recusal occurred.”
In 2017, Purdue Pharma got Pike Circuit Judge Steven Combs to seal the case file, including the only deposition from a member of the Sackler family that owns the company. Stat, the health-and-science publication of The Boston Globe, asked Combs to unseal the file, and Beshear’s office took no position on the issue (after denying an open-records request for the deposition, citing Combs’ order). Combs granted Stat’s motion, but Purdue has appealed.
As attorney general, Beshear has sued nine opioid manufacturers and distributors, alleging that they caused or worsened the opioid epidemic, which has left thousands of Kentuckians dead from overdoses. He says no other attorney general in the nation has filed as many suits against opioid makers and distributors. Bevin has noted that none of the suits have resulted in settlements.