In Senate race, McConnell and Grimes differ on health care

By Cheyene Miller
University of Kentucky School of Journalism and Telecommunications
               The U.S. Senate race between Republican Sen. Mitch McConnell
and Democrat Alison Lundergan Grimes has seen the candidates focus on several
key issues, including the coal industry, the minimum wage and health care.
               The
health-care issue has been almost unique among Senate races in that Kentucky is
generally seen as a success story for the Patient Protection and Affordable
Care Act. In August, Gov. Steve Beshear said 521,000 of Kentucky’s 4.3 million
citizens had signed up for health coverage through Kynect, the state’s health
insurance marketplace created under the law.
               According
to a Gallup-Healthways poll, published in August, Kentucky reduced its
percentage of uninsured more than any other state besides Arkansas, and lowered
the percentage of uninsured in the state from 20.4 percent to 11.9 percent,
thus covering two of every five uninsured Kentuckians.              
In addition to funding the
expansion of Medicaid, the law requires Americans to either purchase private
health insurance or enroll in some form of government assisted health care like
Medicaid; requires insurance companies to cover people with pre-existing
conditions and provide 10 elements of coverage in each policy; allows parents
to keep their children on their health insurance until they are 26; and
requires businesses employing 50 or more full time employees to provide health
insurance, a provision that President Obama has suspended for a year.
McConnell says he wants to repeal
the law “root and branch,” but has been more lenient toward the idea of keeping
Kynect. In the Senate race debate on KET, McConnell suggested that Kynect was
merely a website. However, repealing the law could pose issues for the newly
insured in Kentucky because private insurance under Kynect uses federal tax
credits, and provides free Medicaid coverage to citizens who earn up to 138
percent of the federal poverty level.
According to Douglas McSwain, a
Lexington-based litigation attorney who specializes in constitutional and
health-care law, the uprooting of the law would result in drastic changes to
Kynect.
               McSwain
said repealing the ACA “root and branch” would mean cutting the federal tax
subsidies that are essential to Kynect’s survival.
“You take the exchange tax credit
away, do you think for a minute that the website is going to stand?” McSwain
asked.  “Nobody is going to buy
policies.”
At a Kentucky Farm Bureau forum in
August McConnell said Congress should have passed laws allowing health
insurance to be sold across state lines, limiting malpractice lawsuits and
making it easier for businesses to form health-insurance groups.
               McSwain
said the law allows formation of such groups, and interstate regulation “is
conceivable” but “The problem is we don’t have the infrastructure,
regulatory-wise, to do that without having reached a compact or an agreement”
among the states.
               A study
on the effects of malpractice reform, published by the New England Journal of
Medicine, found that Texas, Georgia and South Carolina did not see a
significant reduction in the amount of doctor-ordered tests and scans after
enacting reforms.  A five-person team of
doctors performed the study, collecting data from 1997 through 2011.
               Grimes
has only publicly discussed health reform on select occasions, taking a similar
strategy to many Democrats in the 2014 midterm election because of the
unpopularity of “Obamacare” and its namesake. 
When she does mention health care, she talks about fixing and
streamlining the law, as she did during the KET debate.
“I will not be a senator that rips
that insurance from their hand,” Grimes said in reference to the half a million
Kentuckians who’ve gained coverage under Kynect.  She said McConnell was in a “fictional
fantasyland.”
Grimes has also talked about
supporting an extension of Obama’s “grandfathering” of insurance policies that
don’t comply with the law after he was criticized for not keeping his campaign
promise that Americans could keep their doctor and health plan if they liked
them.
               That
controversy and other aspects of the law have led to negative feelings among
Kentuckians about Obamacare.  A poll by
Marist College for NBC News showed Obamacare had a 33 percent approval and 57
percent disapproval rating among Kentuckians, while Kynect had 29 percent
approval and a 22 percent disapproval., while 29 percent of those polled said
that they had never heard of Kynect and 21 percent were unsure of how to rate
it. 
               At last
report, about 80,000 Kentuckians had bought private insurance through Kynect
and about 440,000 had used it to get on Medicaid – 320,000 of whom were
eligible under the new rules and 120,000 under the what state officials call
“old Medicaid.” The federal government pays about 71 percent of “old Medicaid”
costs and, until the end of 2016, 100 percent of the newly eligibles’ coverage.
In 2017, it will pay 95 percent of the new costs, and fall to the reform law’s
floor of 90 percent in 2020.

Cheyene Miller of London, Ky., wrote this story for
“Covering the U.S. Senate Race,” a special course in the University of Kentucky
School of Journalism and Telecommunications.
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