Health care factors into Senate race

By Cheyene Miller

[email protected]

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 Kentucky minimum wage and health care.

The health care issue has been unusual 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 act.

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. The law also 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 Barack Obama has suspended for a year.

McConnell said he wants to repeal the Affordable Care Act “root and branch,” but has been more lenient toward the idea of keeping Kynect. In the Oct. 13 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 said. “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 that “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 Georgia, Texas 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 headed the study and collected 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 potential unpopularity of “Obamacare” and its namesake with voters. 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 have gained coverage under Kynect. She said McConnell was in a “fictional fantasyland.”