Saturday, January 11, 2014

Health scare in Kentucky

The Affordable Care Act (ACA) has had some notable success in Kentucky.  In 2013, there was an estimated half of a million Kentuckians who did not have health insurance.  Kentucky was one of the few states that embraced the ACA and health care exchanges.  They created their own health care exchange known as Kynect.  The Democratic Governor of Kentucky Steve Beshear embraced the ACA and took advantage of the expansion of Medicaid for the citizens of Kentucky.  Over 70,000 of Kentuckians have been able to sign up for Medicaid under the expanded coverage.  About 25,000 have signed up for private health insurance through the newly created state exchange system.  All told, because of the ACA, nearly one-fifth of Kentuckians who did not, previously, have health insurance, now have health insurance.  Perhaps because of the wide-ranging implications, 43% of Kentuckians believe the ACA has had a successful implementation in Kentucky, although the same amount of Kentuckians believe the implementation in Kentucky has been unsuccessful.  Despite those seemingly good numbers, 56% of Kentuckians still disapprove of the ACA.  This is most likely caused by just 22% of Kentuckians viewing the implementation of the ACA as a success on the national level.

This should not be surprising, I guess. Only 3% of Kentuckians who voted for Mitt Romney in 2012 approve of the ACA, the approval of the ACA comes, almost entirely, from Barack Obama voters.  71% of Obama voters approve of the ACA.  But, how do voters view the implementation of the ACA in Kentucky?  22% of Romney voters believe that the implementation in Kentucky is a success.  75% of Obama voters think that the implementation was successful in Kentucky.

The implementation in Kentucky was not perfect.  On October 1st, when the exchanges were opened, Kynect's website crashed for six hours.  But more servers were added that doubled capacity.  Kynect's online capacity increased 80% in December.  The call center's availability changed and are now open seven days a week to help with the increased demand.  40% of the new enrollees are under the age of 35 which is seen as a positive sign for the long-term stability of the ACA.  Most of these things should be as a fairly successful implementation of such a comprehensive new health care law, especially compared to the unsuccessful rollout at the national level.

But why aren't more people seeing it as a success or have a more positive view of the law?  Well, Republican lawmakers have built a fairly successful campaign against the ACA.  The attacks will likely continue.  Senator Mitch McConnell has continued to be critical of the law and uncharitable to the success of the law.  Deriding those who signed up for the law, McConnell claimed that the ACA only has had this level of signups in Kentucky because they are essentially offering a free program in Medicaid.  The attacks on those who receive benefits of the government always play well in states, such as Kentucky.  Kentucky has a sizable amount of low-income white voters who have a distaste for the federal government.

Kentucky's Junior Senator has announced his own horror story with the ACA and Medicaid, that certainly will play well to a number of Kentucky voters.  Unfortunately, Paul's story does not pass the smell test.  Paul claimed that his son was told he didn't exist, which is not a message that he would receive.  But it's possible, that he had to prove who he was because he may have little or no credit history from the report from Experian.  The younger Paul was somehow signed up for Medicaid, which the older Paul claims nobody wanted.  As someone who has signed up for Medicaid through MediCal, I can tell you that there is a process where you have to verify that you want to sign up for it and prove that you are eligible for it.  People are not signed up, just because they show up at the local welfare store.  More likely, the younger Paul incorrectly filled out his form by not stating that he was claimed as a dependent by his father.  There are a variety of forms that I had to fill out and many people I had to talk to, in order to be determined eligible for MediCal.  I really wish it was as easy as the elder Paul seems to sign up for Medicaid, it would have been much easier for my girlfriend and I to receive health insurance that we both needed.

The most popular politician in the state, Governor Beshear, believes in the positives of the ACA.  He has advocated for Democratic politicians to stop running away from the ACA and start running on it.  Beshear has offered the idea of looking for a longer view, stating that by 2014, the ACA will be seen as a net positive.  This is a view, I also subscribe to.  He also opined that Kynect was more popular in Kentuckians' eyes than the ACA.  This is certainly possible, almost certainly probable.  There's confusion of how the ACA will impact voting in Kentucky, because of Kynect's success.

Beshear's favorability in Kentucky dwarfs that of any other statewide politician, net favorability at +18.  Beshear was elected with 56% of the vote in 2011 while Democratic candidates won all but one statewide elections.  Despite Beshear's popularity, 44% of Kentuckians want a Republican as the next Governor of Kentucky, while 37% want a Democratic Governor.  This is not surprising at all, considering Kentuckians are generally more likely to vote Republican than Democratic.  Beshear's favorability among Republicans is 34/46, which is not terrible. His net favorability among Democratic Kentuckians is +41 and among Independents, it is +8.  He outperforms Kentuckians' views on the success of the ACA.  If Beshear continues on his crusade to advocate for the ACA, his popularity might slide a bit, but the popularity of the ACA will likely increase.      



  1. If I understand correctly, one of the biggest questions you are raising is why, if so many people are getting medical insurance because of the ACA, are so many people opposed to it? You seem to blame it on Republican politicians and there opposition to the law, but I think there are some very good explanations other than that.

    1. If I understand the individual mandate correctly, a lot of these people are required by law to purchase health insurance. I don't think it is a stretch to believe that some people might resent being forced to buy a product that they would not have otherwise.

    2. Even if some people are glad to have health insurance, it is not hypocritical to oppose the program that made it possible. A fallacy of composition is the belief that what is good for a part, is good for the whole. Perhaps many of those who have health insurance for the first time think that the policy in general is bad for their state or nation, even if they personally benefit.

    3. You point out that 40% of the new enrollees are under 35. Perhaps many of these people realize that their premiums are subsidizing the premiums of the relatively old.

  2. Neal, as always, you bring up some good points. There are some other explanations as to why the ACA is not popular in Kentucky, despite being a success. I chose Republican politicians' responses and how they framed the issue, in part, because they have two of the most vocal critics of the laws as Senators and Kentucky, itself, is a Republican state.

    I'll work backwards through your points.

    It's possible that young people in Kentucky are realizing subsidizing older people. 44% of 18-29 year olds believe the implementation was successful in KY. 50% think it was unsuccessful. Basically the same numbers for the state, as a whole, but 18-29 year olds are more Democratic than their respected counterparts, so you'd expect it to be slightly higher. 18-29 year olds have an ever so slight higher approval rating for the ACA at 33/57 compared to the rest of the age groups. They also have a slightly higher rates of thinking the ACA is being successfully implemented in the US at 31/67. All these numbers are from the PPP poll I posted in the article. What's curious when you look at that cross tab, there is almost no relationship between ACA approval and successful implementation in Kentucky. Looking at this cross tab, was what got me interested in how it was viewed.

    Your 2nd point is a valid point. The people may believe that the ACA is bad for the state or nation, as a whole. I'm not sure if PPP even was able to ask any Kentuckians who signed up through Kynect. While there is a total of about 100,000 people signed up, in a state of over 4 million, it would be pretty lucky to get them on the phone. Even luckier to get one of the ones who signed up for private health insurance that is not Medicaid. Again, even though, it is a relatively good number, the poll probably did not even talk to anyone who knows someone who signed up through Kynect. But anyway, the people may think that the policy is bad for their state or nation. The question is why, I posit that it's because of politicians talking about Medicaid, people getting government benefits for free, government takeover of healthcare, people losing health insurance, etc. If Beshear is right and Kynect has a higher popularity than the ACA, then we must ask why. Is it because they think the policy is bad for the state or the nation, or are they just poorly informed? It seems unlikely to me that we are talking to people who have been personally affected by the ACA, but rather we are talking to people who see the ACA still, as a ghost story or an internet rumor.

    Yes, these people might resent being forced to buy a product. But I don't know how likely it is that the poll even talks to people who previously did not have health insurance.