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Health care could still be Democrats’ legacy

First Posted: 11:53 am - December 2nd, 2015

Al Cross - Contributing Columnist




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FRANKFORT – When Steve Beshear made an unusually emotional plea for Republican Gov.-elect Matt Bevin to leave the state’s new health-insurance system alone, some of the governor’s fellow Democrats wondered why he hadn’t been more vocal about the landmark achievement of his eight-year governorship.

The next day, author-farmer-poet-philosopher Wendell Berry came to the table I shared with my brother at the Kentucky Book Fair and asked, more or less, “Wonder what would have happened if Beshear had gotten up on his hind legs before the election?”

My short answer is that it would have taken a lot more than Beshear’s involvement to elect Jack Conway, probably more than was possible in an election in which Democrats faced a perfect storm: Bevin’s outsider status, Conway’s shortcomings as a candidate, his support of same-sex marriage, and the unpopularity of President Obama and his policies.

A longer answer illustrates the difficulty Democrats have in defending what should be their greatest policy accomplishment since the passage of Medicare and the Voting Rights Act 50 years ago.

Soon after Beshear implemented Obamacare by expanding Medicaid eligibility and creating kynect – a health-insurance exchange where people sign up for Medicaid or buy subsidized insurance – he said the reforms would be a political plus for Democrats in future elections.

But that didn’t prove true for Secretary of State Alison Lundergan Grimes in her 2014 challenge to Republican U.S. Sen. Mitch McConnell, and it didn’t fit the campaign plan of Conway and his advisers. They didn’t run a single TV commercial about health care.

“Anything with Obama’s name attached to it drops like a rock, and it was very hard to educate a community and motivate a community when basically you’re just arguing over the name Obama,” said Conway consultant Mark Riddle. He said that when their pollsters “tried to explain it’s a Kentucky system, the numbers never jelled out to run paid advertising on it.”

Republicans were already tagging Conway with the Obama label, but Riddle said he believed that Obama was so strongly associated with health care that using the issue in paid TV, even if Republicans didn’t respond with an Obama-oriented attack, would not have helped Conway and might have even backfired.

“All of these angles were very diligently thought through from all levels of the campaign,” Riddle said. He said Beshear has the right policy, but “It doesn’t work politically.”

Riddle disagreed with a pre-election assertion in this space that Conway needed a phone-and-mail campaign aimed at the 400,000 people on expanded Medicaid. He pointed to anecdotal signs such as Bevin carrying heavily Democratic and Medicaid-dependent Breathitt County. But Obama’s coal policies were also an issue there, and more so in counties like Harlan, where he did even better. His statewide margin was almost 85,000.

Bevin had given Conway an opening by saying in the primary that he would abolish the expansion. In July, he denied saying that, and started talking about a scaled-back program, but Conway had the ammunition. Whether it would have worked is open to question.

A phone bank to identify Medicaid-expansion enrollees would have cost perhaps $250,000, but direct mail and get-out-the-vote phoning might have cost that much more. The effort might also have needed an even more expensive voter-registration campaign; Medicaid recipients probably change addresses more than most people. Finally, a registration effort wouldn’t fit Conway’s low-turnout strategy, and the targeted voters might have found reasons to vote the other way.

State Democratic Chair Patrick Hughes said it might have been a good idea to have a stronger mail campaign aimed at Medicaid recipients, or even TV commercials from Conway about the issue. But he said the result of the election probably wouldn’t have been different, even if those measures had been coupled with a push by Beshear.

“It is a relatively complicated issue,” Hughes said “It takes more time than the average campaign to really get that out there.” Meanwhile, “The Republicans have done a very good job of vilifying Medicaid and kynect, be it through calling it Obamacare or talking about all the potential negatives of health-care reform.”

The conventional wisdom about Beshear’s role is that he didn’t want to take a high profile on a controversial issue for fear of eroding his broad-but-thin popularity, which was probably decisive in his son Andy’s 2,200-vote win in the race for attorney general. The governor wouldn’t grant an interview, but did send me a statement:

“In every campaign speech I gave this year, I highlighted Kentucky’s economic momentum and our other successful programs, including our success in offering all Kentuckians access to affordable health coverage, because that is a game-changer for Kentucky and the health of our people. I was not in control of the messaging for the Conway campaign. They made their own decisions and ran their own campaign, and that’s the way it should be. If Jack had addressed the health-care issue more, people might have had a better understanding of how important this election was to that issue. But there is no way to know if that approach would have made any difference in the outcome.”

Sounds like Beshear would have run the campaign differently. Still, his legacy is likely to last; people may not vote for Democrats for giving them health care, but they would be much more likely to vote against Republicans for taking it away. That’s probably why Bevin reversed course on Medicaid. He seems determined to abolish kynect to score a political point against Obamacare’s brand in Kentucky, but Medicaid is a lot more important – for the politics of his Republican allies, and for the health of Kentuckians.

Al Cross, former C-J political writer, is director of the Institute for Rural Journalism and Community Issues and associate professor in the University of Kentucky School of Journalism and Telecommunications. His opinions are his own, not UK’s. This column previously appeared in the Louisville Courier-Journal.

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Al Cross

Contributing Columnist

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