The New York Times ran a front-page story Wednesday on the health care disconnect in Kentucky. The premise: Despite the Affordable Care Act implementation going as well here as anywhere else in the country — nearly cutting our uninsured rate in half — most people are vehemently against “Obamacare” because of the unpopularity of its namesake. The story opens with Robin Evans of Louisville, who explains that she will vote for a man who wants to repeal the law that gave her family health care coverage.
The Affordable Care Act allowed Robin Evans, an eBay warehouse packer earning $9 an hour, to sign up for Medicaid this year. She is being treated for high blood pressure and Graves’ disease, an autoimmune disorder, after years of going uninsured and rarely seeing doctors.
“I’m tickled to death with it,” Ms. Evans, 49, said of her new coverage as she walked around the Kentucky State Fair recently with her daughter, who also qualified for Medicaid under the law. “It’s helped me out a bunch.”
But Ms. Evans scowled at the mention of President Obama — “Nobody don’t care for nobody no more, and I think he’s got a lot to do with that,” she explained — and said she would vote this fall for Senator Mitch McConnell, the Kentucky Republican and minority leader, who is fond of saying the health care law should be “pulled out root and branch.”
Ms. Evans said she did not want the law repealed but had too many overall reservations about Democrats to switch her vote. “Born and raised Republican,” she said of herself. “I ain’t planning on changing now.”
Polling in Kentucky has consistently shown that while “Obamacare” is very unpopular — support in the mid-30s and opposition close to 60 percent — the specifics of its implementation in Kentucky are, if not downright popular, far from toxic. Kynect itself is consistently approved of by many more than those who disapprove of it. Gov. Steve Beshear’s decision to expand Medicaid under the ACA — where most of the over 500,000 Kentuckians have gained coverage this year — is given the thumbs up by a clear majority, even as high as 79 percent.
Other features of the law — such as children staying on parents’ coverage until age 25 and the prohibition on insurance companies denying coverage for pre-existing conditions — have not been polled recently, but have polled very high in the past and are not likely to have changed much.
But still, many remain either indifferent or confused as to what health care reform really is in Kentucky. The majority of Kentuckians who support Medicaid expansion and patient protections under the law must by the laws of mathematics include many of the same people who say they disapprove of the ACA that made them possible. Likewise, the roughly half of Kentuckians who aren’t sure what to make of Kynect must include these same people quick to say they don’t like Obamacare, even though they are essentially the same thing.
The reasons for this disconnect are many and are closely tied to the decision of Alison Lundergan Grimes’ campaign to steer clear of the issue. But this decision by Grimes to avoid talking about the benefits of health care reform is not just an effect of the disconnect, it is also a cause of the disconnect, itself.
While there has been a wealth of attacks on and misinformation about the law in Kentucky over the last four years — outside of a few staunch defenders like Beshear, Congressman John Yarmuth and liberal editorial boards — no one is doing the heavy lifting to educate the public. This is highlighted by the disparity in television ads, the most effective way to get into the heads of a large number of voters. Kantar Media released a study in May showing that since the ACA was signed into law, the number of anti-ACA television ads aired nationally have been 15 times greater than pro-ACA ads. A Wesleyan Media Project study in April showed that a good portion of Kentucky has been ground zero for anti-ACA ads nationally since 2013, as seen in their chart below. Have you ever seen a pro-ACA ad in Kentucky? Me neither.
Many progressives and pundits over the past few weeks have opined that Grimes should kickstart her lagging campaign by finally making health care reform a major issue, pointing out that McConnell wants to repeal the law and take away the coverage of the large majority of the over 500,000 Kentuckians through Kynect. To that point, one can argue this strategy would help her most in the region of Kentucky where she seems most vulnerable: deep in Appalachia, where Kentucky has seen the most dramatic decrease in the uninsured rate because of health care reform. Democratic Sen. Mark Pryor of Arkansas — the only state to reduce its uninsured rate more than Kentucky — has begun flipping the script in his race by defending the law in campaign ads, while the “repeal Obamacare” mantra among Republican candidates and outside conservative groups has suddenly died down to a whisper. Even McConnell has stopped pushing the repeal message aggressively of late, instructing fellow Republican senators not to emphasize repeal when they travel home to meet with constituents this month.
Despite the merit of these points, the most obvious reason why Grimes — who does actually support keeping and fixing the ACA, albeit quietly — has not done so is that President Obama is absolutely toxic in most of the areas she believes she needs to gain support. Facing an opponent with a tremendous amount of money ready to morph her into Obama, Grimes is afraid any embrace of health care reform will only make their job easier. After all, with so many swing voters already confused about what Kynect really is — and McConnell trying to take advantage of that confusion by suggesting the parts of reform Kentuckians like could survive the repeal of the ACA — his job is already halfway complete.
But here lies the main difficultly of Grimes suddenly putting the issue at the front of her campaign and TV ads: Overcoming years of attacks on the law to clearly define its benefits and the negative ramifications of taking it away will take much more than a month of TV ads and stump speeches. This would be like beginning your doctoral dissertation the night before it is due. If Democrats truly wanted to stop playing defense and start playing offense on this issue, this should have been started a long time ago with a concerted effort that involved more than Beshear making appearances on cable news to tout its success in Kentucky.
In fact, many Democrats have actually enabled confusion over the law. Last month, I asked Democratic House Speaker Greg Stumbo if Obama deserved any credit for the 500,000 Kentuckians now insured through Kynect.
“I think they should be grateful for Gov. Beshear mainly,” said Stumbo. “You know, we call it Beshearcare. Because, to me, what Obama messed up in Washington, that mess up there is Obamacare … (Beshear’s) version of the Affordable Care Act is a little bit different, I think, than what Obama does up in Washington. Obama makes a mess out of everything. Gov. Beshear, to his credit, has extended benefits to 500,000 working Kentuckians and elderly Kentuckians who never had coverage before, so he should be credited for that.”
This “Beshearcare” rebranding — also pushed by Beshear’s KDP — might make sense if you’re thinking in the short-term. Wanting to win key state House races this year that will determine the chamber’s majority, they want people to think Democrats are for the “Beshearcare” they like but against the “Obamacare” and president they hate. The problem is that back in the real world, these two are the exact same thing. If you support Kynect, you support Obamacare by default, which millions of dollars of GOP ads will point out.
This strategy of bashing Obama to save yourself may be a “safe” way to inoculate in the short-term — see the anti-Obama campaigns of Beshear and Jack Conway in 2011, and everything involving coal among most Kentucky Democrats — but in the long term it likely ruins the brand of being a “Democrat” in this state. Try as they might to trash Obama and say he’s something different, voters in the ballot box still see the same “D” next to his name and theirs’. Plenty of Democrats have actual real disagreements with Obama on policy, but this manufactured stiff-arming of the ACA only serves to poison the well even further on a revolutionary health care reform that could be their shining accomplishment to show off to voters.
So even if Grimes shocks everyone by shifting strategy to aggressively embrace health care reform — more than just a few lines out of a stump speech or one debate answer — there is a pretty good argument that it is too little, too late. And while Grimes’ campaign could take a lot of the blame for this lost opportunity, there’s plenty of blame to go around among Kentucky Democrats.