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You are here: Home / Anderson On Health Insurance / Entrenching the ACA

Entrenching the ACA

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Kentucky is the test case to see how embedded a fully implemented and operational Death Star  Obamacare really is.

It has a virulently anti-Obamacare governor and a political configuration that is not particularly supportive of broad based social welfare programs. And yet Obamacare survives. It takes a few punches as Kynect has shut down but the core functionality transfers to Healthcare.gov. The Medicaid Expansion is fundamentally intact even as Governor Bevin makes waves at seeking a harsh, punitive and counter-productive 1115 waiver.

Kentucky can do marginally dumb things that makes Obamacare work less well and reach fewer people but the Kentucky political establishment is unwilling and unable to kill implementation in their state because it costs too damn much.

This is good news for the morning.

Reader Interactions

33Comments

  1. 1.

    sherifffruitfly

    only live question is whether it’s entrenched enough so that hillary can’t ruin it. we’ll see.

  2. 2.

    Paul in KY

    From what I’ve heard, shutting down KYNECT means we have to refund Feds $40 million. Yay, Bevins!!

  3. 3.

    p.a.

    how many more Koch/Heritage/OppressedCatlic lawsuits are still wasting resources percolating up the system? #scaliastilldead!

  5. 5.

    Betty Cracker

    @Amir Khalid: Because she’s eeeeeeeeeeeee-ville!

    Regarding the entrenchment of the ACA, it’ll be interesting to see how it plays out in KY’s meth lab of democracy, but it would be unwise to forget the GOP’s willingness to stomp its own dick if that’s what’s required to satisfy the base’s pathological need to beat back progress led by a Democrat. Governor Rick Scott of Florida demonstrates that daily.

  8. 8.

    Patricia Kayden

    @sherifffruitfly: And what evidence do you have that Secretary Clinton wants to ruin the ACA? It’s one thing to criticize Secretary Clinton for things she’s actually done. It’s something else altogether to criticize her for things she has given no indication of doing. Sigh.

  12. 12.

    Mnemosyne

    @jo6pac:

    Pre-Obamacare, several states — including Hawaii, Vermont, and California — all had proposals for their own single-payer system, but none of them ever went through. Obamacare has a pretty fair amount of flexibility built in for state proposals like this, so if Colorado could come up with a workable plan, they could probably get the necessary waivers and still keep their federal Medicaid money.

    As a small-population, high-cost state, Colorado does have unusually high healthcare costs for its size, so it will be interesting to see if they can come up with a workable plan.

  14. 14.

    Miss Bianca

    @jo6pac: Repre-SENT! Yup, we have been having lively discussions over here in rural Custer County as we debated adding support for Amendment 39 to our county Democratic platform planks. I believe it made it all the way to the state level.

  16. 16.

    TriassicSands

    The only article about Bevins that would be “good news” would be an obit. Sorry for the harsh opinion, but Bevins, like almost all Modern Republicans, is an evil, hateful, barely human creature.

  18. 18.

    Jack the Second

    I’m curious how the reliance on Heathcare.gov will affect perceptions of the federal government’s role in healthcare as time goes on.

    With Kynect and all of the other state-based systems, you could pretend this was totally independent of Obamacare, say, we don’t need no stinkin’ Obamacare, we have Kynect here in Kentucky. I bet you’d beat the normal 27%, in how many people’d believe that. Healthcare.gov, that’s Obamacare, for sure. Only the craziest of crazies could think you’d repeal Obamacare and still be able to buy insurance through Healthcare.gov.

  19. 19.

    jnfr

    @jo6pac:

    I’m in CO as well, and I find it hard to believe this will pass, though I’d love to see it. Senator Bennet (up for reelection this year) has already come out against.

  20. 20.

    Fake Irishman

    @Mnemosyne: I think of the problems that Vermont had with their attempt to create a Single-payer system. It’s a heavy lift for a small state. If a large state wanted to try, or perhaps a consortium of larger states, you might get something you could build off of.

  23. 23.

    BR

    Why not create a state run public option that merges with the in-state medicaid pool? I’ve been waiting for a public option here in CA — Blue Shield is awful.

  24. 24.

    Fake Irishman

    Good post Richard. I would also add that the experiences of Arkansas and Arizona, where more reactionary elements took over the governor’s chair (Arizona, at least on the ACA) or party control flipped (Arkansas) match your observations of Kentucky. In Arizona, the ledge passed a “we’re going to hold our breath” resolution demanding the HHS allow the state to attach work requirements to the program and Arkansas has modified their program somewhat (in many cases to resemble a more traditional expansion) while making noises about how unfair the whole thing is because it’s destroyed the marvelous system of charity care they had set up (/snark). I’ve written about this a bit here and here

  25. 25.

    Fake Irishman

    @BR: Minnesota and New York are looking at variants of this idea with the state basic plan states can set up under Obamacare. I think Minnesota wants to take it farther and get a waiver for a full-fledged public option.

  26. 26.

    amygdala

    A little tangential/OT, but interesting: Administration Expands Medicaid To Cover Former Prisoners In Halfway Houses
    Little by little, the gaps in the system are getting filled.

    I took care of a lot of inmates in the hospital and clinic and arranging followup care once they were out of custody could be really hit or miss. Happy to see the administration exercising its usual patience to improve things for a group of people society tends to ignore (or worse).

  27. 27.

    The Gray Adder

    Maybe next time the KY Democrats will run somebody who sucks less than Jack Conway.

  28. 28.

    Frankensteinbeck

    To the OP, it’s interesting that Bevin removes the part of Obamacare he said he wasn’t going to remove, and leaves intact the actual Obamacare he said he’d get rid of.

    @The Gray Adder:
    Won’t make any difference. I saw Conway do exactly what outside Democrats said he should do in his run against Rand Paul, attacking Paul relentlessly on his goofy, extreme positions that Paul tries to sweep under the rug. In Kentucky, that means bupkis. The state, already red, flipped the fuck OUT when a black man became president. I lived there, and it is a hellhole of racism and spite.

  29. 29.

    Richard Mayhew

    @BR: I’m working on a post that would describe how a state could build and finance a competitive public option. It is fairly complex and it might not work in all states.

  31. 31.

    ThresherK (GPad)

    Gov Bevins should be made to show up at a White House presser, where Obama gives him a big cardboard check. Just like a lottery winner. Fudge knows Bevin didn’t do anything but luck into this.

  33. 33.

    Paul in KY

    @Frankensteinbeck: He didn’t expand the electorate. He needed to get out the Democratic voters & he needed them to be fired up. Bevin’s wackos were fired up about the Kim Davis clusterfuck. How did Conway get ours fired up? How much did he campaign in the West End?

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