And now that officially sucks.
Tue Nov 03, 2015 at 5:22 PM PT (David Jarman): To recap, Republican Matt Bevin (whom you might remember from losing his tea-flavored primary challenge to Mitch McConnell in 2014) has won a surprising (to the extent that no poll had given him the lead) victory in Kentucky’s gubernatorial race.
Bevin (R-Sociopath) had run on a promise to repeal as much of PPACA as he could. That means shutting down Kynect, the Kentucky exchange and turning down the very successful Medicaid expansion. As Charles Gaba noted, he was promising to take away health insurance from 9% of the state. And he looks like he won going away and with coattails.
— Charles Ghooooulba (@charles_gaba) November 4, 2015
There are two major health policy implications of a Bevins win. The first is the switch from Kynect to Healthcare.gov. This is not that big of a deal in and of itself. It is a different portal and a different set of branding but subsidies flow to people who buy insurance from healthcare.gov after the King case. The biggest downside is if Kentucky wanted to go the Wyden Waiver route, having their own exchange makes plumbing a Wyden Waiver, even a very conservative Wyden Waiver a whole lot easier.
The big policy change is Medicaid expansion. Medicaid expansion covered approximately 420,000 Kentuckians as of this morning or 9% of the state. Bevin ran against expansion. The best case scenario is the hospital groups march into Bevin’s chief of staff office tomorrow and tell him flat out that their books don’t balance without expansion of some sort and they’ll lay covering fire for an extremely punitive waiver application. That is the best case scenario and I’ll give it a 10% chance of happening. The probable case scenario is 420,000 people are fucked as of February 1, 2016 and most of Appalachian Kentucky has medical care and medical financing resembling Third Wold nations again.
Kentucky, a red state, is highly likely to return to being a purple state on the New York Times Upshot map of uninsurance rates:
It was a good two years of actually connecting people to health insurance without the death defying worry that a toothache could either be immediately fatal or financially destroying.