As Obamacare spreads in Kentucky, the state remains conflicted about it and other forms of government help

By Al Cross
Kentucky Health News

Even as Obamacare coverage spreads in Kentucky, more widely than in almost any other state, the commonwealth remains conflicted about it and other forms of government aid -- creating a political battle that is likely to continue at least until the November 2014 elections, and perhaps into the governor's race in 2015.

The federal health-reform law and its presidential namesake have been the centerpiece of the U.S. Senate race, with Republican Sen. Mitch McConnell railing against it, primary challenger Matt Bevin saying McConnell hasn't done enough to dismantle it, and likely Democratic nominee Alison Lundergan Grimes keeping mostly mum as she waits for the political landscape to settle.

McConnell's Kentucky strategy is part of a national game plan, in which "Republicans are launching a class war with racial undertones—and hurting the poor whites they'll need to win in 2014," the respected, non-partisan National Journal said in a cover story in its weekly magazine over the weekend, reported from Louisville by political writer Beth Reinhard. It is titled "Return of the Welfare Queen," a trope popularized by Ronald Reagan.

Reinhard first looks beyond Kentucky, noting that "25 Republican-led states have — astoundingly" rejected expansion of Medicaid under the law. "To justify this unprecedented rejection of federal relief, these governors and state lawmakers say they just do not believe Washington will keep its promise to pick up the tab. Republicans in Congress are egging them on, denouncing Obamacare's disastrous launch as proof of the arrogance and folly of big government."

"The chances of the federal government picking up the tab for the newly eligible Medicaid people long term is zero, which means that the next governor, whoever that may be, is going to be stuck with a huge, huge problem," McConnell said at a Nov. 12 press conference which he limited to the subject of Obamacare. "The Medicaid expansion that we have already experienced, the Medicaid increases that we've already experienced, is the principal reason your kids' college tuition is going up. . . . So we're paying for it already."

National Journal's coverage has a video, the middle frame of which
shows Gov. Steve Beshear and House Minority Leader Nancy Pelosi.

Thus did McConnell conflate recent increases in Medicaid spending with Democratic Gov. Steve Beshear's expansion of the program to households earning up to 138 percent of the poverty line, from the current 69 percent. That will cost the state nothing for three years, because the federal government will pay the entire cost of care for the newly eligible. In 2017, the state will begin to hep out, hitting the law's 10 percent cap in 2020.

Reinhard notes that Republican "tirades" also target food-stamp recipients, and "Pitting makers against takers is simply smart, hardball politics for some Republicans whose "primaries that will be largely decided by a mostly white conservative base that hates the welfare state. . . . Class warfare can work in a primary. But, ultimately, Republicans' scorn for antipoverty programs hinders the party's efforts to expand beyond its conservative base."

Reinhard writes, "This opposition carries an unmistakable undertone of class warfare, a theme easy to exploit in states such as Kentucky, packed with low-income white voters who have a strong distaste for the federal government. To hear the rhetoric coming from Capitol Hill and the campaign trail, Medicaid and food-stamp recipients are a bunch of shiftless freeloaders living high on king crab legs and free health care, all on the backs of hardworking Americans."

But sometimes people who hold those opinions are relying on the government, too. Reinhard writes about Terry Rupe of Louisville, whose "household's $13,000 yearly income comes exclusively from Washington," and whom she met at a clinic where he was signing up for Medicaid: "The 63-year-old widower can't remember the last time he voted for a Democrat, and he's got nothing nice to say about President Obama. He's also never had health insurance, although he started working at age 9. Since his wife's death four years ago, he's been taking care of their 40-year-old, severely disabled daughter full time. She gets Medicaid and Medicare assistance."

Nevertheless, Rupe told Reinhard, "I don't have any use for the federal government. It's a bunch of liars, crooks, and thieves, and they've never done anything for me. I'm not ungrateful, but I don't have much faith in this health care law. Do I think it's going to work? No. Do I think it's going to bankrupt the country? Yes." Reinhard cites a poll which found that "A majority of whites believe the health-care law will make things worse for them and their families."

Next Reinhard introduces us to Adele Anderson, a white, middle-aged woman who gets $10 an hour for child care and $86 a month in food stamps, and was also signing up for Medicaid. She told Reinhard, "Democrats are too liberal. They just want to give handouts."

Reinhard observes, "The disdain she and Rupe show toward living on the government dole at the very moment they are doing just that is typical in a state that distrusts Washington as much as it needs federal help. . . . Still, Obamacare is so politically toxic that McConnell continues to flog the law that appears to be working in his own state. What's more, he's disqualifying its fledgling success by inciting class warfare."

At his Nov. 12 press conference, McConnell noted that more than 80 percent of Obamacare signups in Kentucky had been for Medicaid, and said, "You know, if I went out here on the street and said, ‘Hey, you guys want free health care?’ I expect I’d get a lot of sign-ups. The most successful part of it has been if you’re talking about getting people signed up is people who are signing up for something that’s free."

In response, the Grimes campaign issued a written statement: "It's unfortunate that Sen. McConnell chooses to look down on Kentuckians who need health care, instead of working to fix the problems. He ought to help those Kentuckians, not attack them."

Reinhard notes that Grimes has yet to say whether she supports the Medicaid expansion, but concludes: "Because Kentucky did take the cash, 308,000 poor people are now eligible for health insurance in the Bluegrass State. Over the 11 months leading up to the election, McConnell and other Republicans opposing Medicaid expansion will be hard-pressed to explain why they want to take health insurance away from needy constituents who belong to their own party." (Read more)

Beshear says other governors will follow his lead on Medicaid

Associated Press file photo

Gov. Steve Beshear says states that have not expanded the Medicaid program under the federal health-reform law, as he did, will do so in the next few years because their voters will demand it.

“I believe the pressure will be so great over the next three or four or five years, on the states that haven’t gone in this direction, that they will end up just where Kentucky is,” Beshear told Alexander Burns of Politico, in the governor's latest appearance in a national publication.

Burns writes, "It’s precisely the message national Democrats are aching to hear, even – or perhaps especially – from a source as unexpected as a pro-gun, pro-coal, red-state governor who once endorsed using state tax incentives to build a creationist theme park."

The story, headlined "Kentucky's unlikely health care heartthrob," focuses on Beshear's high national profile stemming from his expansion of Medicaid to people earning up to 138 percent of the federal poverty line and the state's successful rollout of a website that is enrolling about 1,000 people a day in Medicaid or private insurance -- unlike the federal government's site, which seems to be getting in order after a disastrous rollout that made many Democrats nervous. He is the only Southern governor to take both steps.

"For anxious national Democrats who have pined for a white knight in the health-care reform debate, Steve Beshear is starting to look like the one they’ve been waiting for – implausible as that development may be," Burns writes. "Amid a torrent of negative national headlines about the Affordable Care Act, the 69-year-old Kentucky governor – a canny Southern operator who’s spent his career at arm’s length from the [national] Democratic base – has charged out of Frankfort as a kind of ambassador-by-default for the controversial law."

Burns says the verdicts on the state and national programs are "far from decided, but Beshear says his mind is entirely made up on both the merits and the politics of health care. From his perspective, voters’ opposition to the ACA is driven largely by a sense of anxiety about how the program may change their lives. If they find a year from now that the law has left their personal care unchanged, or even improved it, public opinion could shift quickly."

State Senate Republican Floor Leader Damon Thayer, "a leading Obamacare critic in the state, said Democrats would pay a price for Beshear’s decision to 'channel his inner liberal Democrat with no election ever facing him again in the future'," Burns writes, quoting Thayer: “While it appears that Kentucky has done a competent job implementing a website, it’s still a bad policy. . . . The people of Kentucky don’t like the fact that he has unilaterally implemented Obamacare without legislative approval, and they don’t like Obamcare.” (Read more)

Lexington TV reporter was moved to donate a kidney to a still-unknown stranger and hopes her story will encourage others

Lexington television reporter Leigh Searcy donated one of her kidneys to an unknown stranger and explained it to her 5-year-old  daughter and 6-year-old son this way: "It's like having two cookies and sharing one with someone who doesn't have one," reports Valarie Honeycutt Spears of the Lexington Herald-Leader.

Searcy, a fixture on WLEX-TV, told Spears that she had not considered donating a kidney until she reported a story about the family of a man who needed a kidney. What inspired her about this family was that it reminded her of her own: young, with two children. The man followed a regimented kidney dialysis schedule and strict diet that dictated his daily routine, but what he really needed was a kidney.

"It's hard to explain," Searcy told Spears. "But I left that home thinking, 'I'm going to get tested to see if I'm a match for him.'" She was not a match for that man, but he eventually got one as a result of her story, and she continued with further testing to see if she would match with someone else who needed a kidney.

Eventually, she was found to be a match for a would-be recipient. Searcy still does not know who the recipient was, but told Spears it was a woman "whom I'm told is doing very well and I'm happy for her." Searcy's surgery took place Aug. 29 and the recipient, who was in the same hospital, received the kidney almost immediately, reports Spears.

Searcy, told University of Kentucky Chandler Hospital officials that she would like to meet the recipient if the woman is willing but understands if it never takes place, Spears reports. "If I don't, I just hope my kidney is doing its job for her ... I just really hope it continues to work for her,'' Searcy said.

Stephen Strup, the James F. Glenn Professor and chief of urology in UK's College of Medicine, told Spears that it's unusual for someone to donate a kidney without having some knowledge of the recipient.
He said Searcy went into the donation with "eyes wide open and really thought about it and felt like it was something she was called to do," he said.

"I was healthy, had healthy children and most importantly, had no family history of kidney problems. Why not help someone if I can? It was a very matter-of-fact decision for me," she told Spears. "I considered the risks. My father pointed out more than once the fact I have two young kids; what if something happened?" Strup, the physician, told Spears, "Life with one kidney is really no different than life with two."

Searcy's husband, Versailles policeman Heath Dotson, told Spears that he decided that it was his wife's decision. "From the beginning, I didn't try to talk her out of it," he said. "I was very proud of her."

Lynne Polly, a donor coordinator at the hospital, told Spears that about 365 people are waiting to get a kidney there. "This year there were about 20 living donors  and 70 deceased donors," Spears writes. "Of the living donors in 2013, only Searcy and one other donor did not know the recipient."
Searcy told Spears the surgery had not affected her lifestyle, and that she is not aware of the missing kidney. A month of the surgery, she was running again, back to her normal routine and had no diet restrictions.

She told Spears that she agreed to share her story with the Herald-Leader because she wants others to consider becoming living donors. "The more people realize how far transplants have come," Searcy said, "the more people will be open to getting tested." (Read moreore)

Want to help? Contact Lynne Polly at (859) 323-5737 or lynne.polly@uky.edu. For more information about being a living donor, visit UKhealthcare.uky.edu/trans.

Free webcast for journalists TODAY at 2 p.m. ET will explore rural use of health-insurance exchanges

If you lack health insurance, you're more likely to live in a rural area. Put another way, if you're rural, you're more likely to lack health insurance. Nearly one in five uninsured Americans live in rural areas, while only a sixth of the U.S. population does. For those reasons, the federal health-reform law is especially important to rural areas, but "In the launch of health insurance exchanges across the country, one issue that has not been explored much is how the marketplaces will affect rural Americans," says the Association of Health Care Journalists. So, AHCJ is holding a webcast at 2 p.m. ET Thursday to explore how rural Americans will use the health-insurance exchanges that opened Oct. 1.

The panelists will be Al Cross, director of the Institute for Rural Journalism and Community Issues, which publishes Kentucky Health News and The Rural Blog; Alan Morgan, CEO of the National Rural Health Association; and Jim Doyle, who covers the business of health care for the St. Louis Post-Dispatch. AHCJ health-insurance topic leader Joseph Burns will serve as moderator.

Viewers of the one-hour webcast will be able to ask questions after the panelists' initial presentations. Registration is not required for the free webcast; a link to it will appear on this AHCJ web page shortly before the webcast begins.