FRANKFORT, Ky. — Strolling in the sunshine on this state’s picturesque Old Capitol grounds, Diana Sims came to a booth where women handed out brightly colored tote bags and answered questions about Kynect — Kentucky’s new custom-built health insurance website created by the Affordable Care Act.
Sims, 53, doesn’t like the health care law and doubts the new coverage will really be affordable. But her husband has been uninsured for years, so Sims figures she might as well check out Obamacare. And — unlike many Georgians — she has an easy way to find out.
Kynect is spreading like a weed in the bluegrass: Dozens of commercials promote it during TV morning shows and University of Kentucky football games. Emissaries of the state beat the drum at hundreds of community forums, fairs and other events. They’re telling Kentuckians that Medicaid is expanding to take on another 308,000 people, and that between Medicaid and Kynect, nearly all of Kentucky’s uninsured will have a shot at medical coverage.
The state of Georgia, meanwhile, has no messages on the air, no boots on the ground, no campaign of any sort to tell its citizens about the coming of Obamacare. It is not expanding Medicaid and did not build its own exchange. Most of the state’s nearly 1.9 million uninsured will continue to go without coverage.
Something more than Tennessee separates Kentucky and Georgia, and of course it’s politics.
Georgia Gov. Nathan Deal, a Republican, sees the law as a gigantic example of government overreaching that would bankrupt his state.
Kentucky Gov. Steve Beshear, a Democrat, believes the law will change the course of his state’s history – finally turning the tide against diabetes and other chronic diseases by providing access to health coverage to Kentucky’s 640,000 uninsured citizens.
“These are the people we go to the grocery with, we go to church with,” Beshear said in a recent interview with The Atlanta Journal-Constitution at his office in Frankfort. “For the most part, they are working folks who simply can’t afford to have health insurance. They roll the dice every day hoping that they don’t get sick. If we have the opportunity to change that, then it’s our moral obligation to do it.”
Deal, who declined to comment for this article, sees the law through a much different prism.
“Georgia cannot afford the billions of dollars of new expenses over the next decade and beyond that expanding Medicaid would entail,” his spokesman, Brian Robinson, said recently. “The governor of Georgia can’t and won’t print money or deficit spend. The administration has refused to work with Republican governors on a workable path.”
Beshear has heard that argument and dismisses it, saying the Medicaid expansion will bring enormous financial and health benefits to Kentucky.
“We’re going to have an advantage over many of these states that continue to resist providing this health coverage,” he said. “I don’t question the motives of any of the other governors in terms of their decisions, but I do know this: they’re going to be missing the boat on behalf of their people if they don’t step up and provide heath coverage to those folks.”
Big changes coming to the Bluegrass State
In his final term as governor, Beshear speaks passionately about the Affordable Care Act and the opportunity to transform one of the unhealthiest states in the country. Although Georgia is much larger, the two states share the Southern curse of bad health, including high rates of smoking, lung cancer, obesity and heart disease.
Kentucky’s attention now is focused on Kynect, the new insurance exchange, where people will begin shopping for coverage on Oct. 1. Kynect and the other state exchanges are aimed mostly at people who don’t get insurance through their jobs, such as the self-employed, students and unemployed.
Georgia joined 33 other states in choosing not to create its own exchange, preferring to let the federal government serve the state.
Beshear has navigated a difficult political path to bring his state to this moment. He is alone among Southern governors in trying to fully implement the law, and he acted alone in Frankfort as well. Rather than try to push the Medicaid expansion through a Republican state Senate, Beshear simply announced in May that he would make it so. He did the same by ordering the creation of Kynect.
Legislative opponents and tea party activists tried and failed to pass a law to stop him and even filed suit, but lost in court earlier this month.
“I have some real concerns about the financial impact on the state of expanding Medicaid,” said Kentucky Sen. Julie Denton, R-Louisville. “I understand the benefits but, at the same time, we are a state that’s having dire budget issues and is this really the time we feel we can take on additional costs?”
It worked in Massachusetts under then-Gov. Mitt Romney, and it will work in Kentucky, Beshear said. He added that a healthier workforce that’s more productive is attractive to businesses that are considering moving to the state.
The way Beshear sees it, Kentucky can’t afford not to embrace the law.
The bottom line: $15.6 billion impact
Kentucky could look dramatically different a decade from now if the law achieves the heights Beshear envisions.
Under the Affordable Care Act, nearly all of the state’s 640,000 uninsured, or 17.5 percent of the population under age 65, would obtain coverage. Nearly half of those would receive Medicaid coverage. The remaining 330,000 or so will be able to shop for private insurance through Kynect.
Kentucky has already received more than $250 million in federal grants to get Kynect up and running. It is hiring 100 people to staff the Kynect call center. Georgia received a $1 million planning grant but ultimately chose not to build its own exchange.
The Medicaid expansion could have a $15.6 billion economic impact statewide, creating almost 17,000 new jobs, according to estimates from an independent study by the University of Louisville. Without the expansion, Beshear said, the health care law will still bring nearly $40 million in additional new costs for the state. The expansion, he said, would mean a net positive of $800 million to the state budget through fiscal year 2021.
“From an economic standpoint, it’s a no-brainer,” he said.
The Medicaid expansion is critical to the Affordable Care Act’s aim of providing health coverage to millions of uninsured Americans. The law calls for states to extend coverage to people with incomes up to 138 percent of the federal poverty level, or about $27,000 for a family of three. The U.S. Supreme Court’s ruling upholding the law last year, however, made the expansion optional for states.
Many health care providers and consumer advocates in Georgia wish Gov. Deal shared Beshear’s views. He doesn’t.
He has remained steadfastly opposed to an expansion, saying that the state can’t afford to broaden an overburdened program that doesn’t work and already costs the state billions of dollars.
Deal estimates that an expansion would extend coverage to 650,000 more people and cost the state an additional $4.5 billion over 10 years that it doesn’t have; others say the figure is inaccurate because the state will be on the hook for about $2 billion in new Medicaid costs even without the expansion.
“The bottom line on Medicaid expansion is this: Regardless of whether the new costs are $2.5 billion, $4.5 billion or $6.5 billion, the state of Georgia doesn’t have the money to pay for it without a huge tax increase, crowding out all other spending or both,” Robinson, the spokesman, said.
‘Definitely puts Georgia at a disadvantage’
Advocates in Georgia, like advocates in Kentucky, argue that the state can’t afford not to expand the program. An expansion would bring in $40 billion in federal dollars and create 70,000 new jobs — many of them high-paying in the health care sector, according to a study by a Georgia State University economist.
Deal’s rejection of the expansion, they say, will leave hundreds of thousands of people uninsured – leading to higher hospital bills and insurance premiums for everyone else. About one in five Georgians is uninsured.
His decision hurts not only the health of Georgia’s residents but its economy, too, said Amanda Ptashkin, head of outreach and advocacy for Georgians for a Healthy Future, a consumer advocacy group.
“Why would an employer move to Georgia if we’re not taking care of our citizens?” Ptashkin said. “It definitely puts Georgia at a disadvantage.”
She added that Georgia taxpayers will be helping to pay for the expansion in Kentucky, New York and other states without benefiting from it themselves.
States may opt to expand Medicaid at any time, and Ptashkin hopes Deal will eventually change his mind. When asked last week whether Deal intends to stick to his decision on Medicaid, Robinson replied: “Our position is our position and will be our position.”
‘People ask, “Is this that Obamacare?”’
Kentucky is on track to potentially be the first state-run exchange to be fully approved by the federal government. The technology has been tested. It’s ready to go.
But an even larger challenge lies ahead — making sure Kentuckians know it exists and trying to clear up a lot of confusion and misconceptions surrounding the law.
At the community meetings and other local events they’ve attended, state workers and volunteers have found that some people believe the law has been repealed. Others fear the government will take away their Medicare benefits. Or they don’t know what Kynect is or that it’s part of the Affordable Care Act.
“People ask, ‘Is this that Obamacare?’” said Carrie Banahan, Kynect’s executive director. “We’ve talked to hundreds of folks who need insurance. We’ve never turned down a speaking engagement.”
Lillie Martin, 63, who also dropped by the Kynect booth at the recent event for seniors in downtown Frankfort, said she has adult children who can’t afford insurance. But she doesn’t know enough about the health law to say whether it might help her kids get coverage.
“It’s so confusing,” she said. “I don’t understand any of it.”
Advocates and Kynect workers must also contend with conflicting messages on news programs and blogs that barrage consumers on a daily basis.
“It’s really hard to have a clear, consistent voice about what is fact,” said Regan Hunt, executive director of the nonprofit Kentucky Voices for Health.
Hunt spends much of her time these days traveling the state to promote the law. She recently ordered 36,000 cocktail napkins with the Kynect logo to reach out to young, healthy adults – a group that often goes without health insurance.
Consumer advocates in Georgia can only be envious of the state-led efforts in Kentucky.
With nearly 900,000 Georgians expected to shop on the exchange, Deal’s rejection of the law means the state isn’t actively trying to get out the message about the exchange. That leaves a much bigger workload for nonprofits and community groups that don’t have the same resources as the state.
‘This administration can’t do anything right’
Earlier this year, Kentucky lawmakers debated two proposed bills that would have taken power to implement the law away from Beshear and place it in the hands of the legislature. Both ultimately died in the Democratically controlled House.
Sen. Denton, the Republican of Louisville, questions the administration’s ability to successfully operate Kynect. She cited troubles in recent years when the state decided to shift Medicaid members into a new type of system within an extremely short time. Physicians went unpaid, and many patients were unable to access services, Denton said.
“It got off to a really bad start. Their only goal was to save money,” she said. “This administration can’t do anything right, especially when it comes to health care. I have real concern about whether they can appropriately run an exchange.”
Beshear concedes there will be bumps in the road as the law rolls out. But he says he’s confident that most people will look back a year and a half from now and wonder “what all that shouting was about because I have affordable health insurance for the first time.”
“Politicians need to divorce themselves from who the president is who got this law passed,” he said. “You don’t have to endorse President Obama to take advantage of the possibility of drastically improving the health status of your people.”
Of course, that’s easier said than done for many Republican leaders, including Deal, who face re-election next year. Beshear is in his second and final term as governor and does not face an election campaign in 2015.
“When you change the health status of 4.3 million people, you’re going to change the history of a state,” he said. “We have an opportunity to do that.”
What it is: Georgia’s health insurance exchange is a website, run by the federal government, where consumers will be able to compare the prices and benefits of dozens of health plans offered by private insurance companies. People will also be able to learn through the exchange whether they qualify for federal assistance to help make coverage more affordable or whether they’re eligible for a government health program.
Who it’s for: The exchange is designed for people who don’t get insurance coverage through their jobs, such as the self-employed, students and unemployed. Workers whose employers don’t offer what the federal government deems “affordable” coverage will also be able to shop on the exchange.
When it opens: The exchange will open Oct. 1 with health plans purchased there taking effect on Jan. 1. Open enrollment lasts for six months.
How to learn more: Find more information on the exchange on HealthCare.gov or by calling a customer service representative for help at 800-318-2596.