OPINION: Kentuckians on Medicaid voted against their own interests, and the Democratic base wasn't motivated

By Cheyene Miller
University of Kentucky School of Journalism and Telecommunications

Back in 2004, journalist and historian Thomas Frank wrote the political book “What’s the Matter with Kansas?”

Frank explores a political landscape historically dominated by left-wing [opulist movements, until conservatives started using social issues like abortion and gay marriage to appeal to the working class.

In doing so, Republicans were able to sway middle class and low-income citizens to vote against their own economic interests.

He argues the political discourse in America’s heartland has moved from discussion of economic mobility and opportunity to culture war issues, which are based in perceived anger toward “liberal elites.” Eleven years later, Kentucky has become the new face of this phenomenon.

Prior to the Nov. 3 gubernatorial election, Kentucky was known as the only Southern state where Democrats dominate most levels of government. But with Republican candidate Matt Bevin’s victory over Democrat Jack Conway, Kentucky might be the new Kansas.

During the campaign Bevin spoke against raising the minimum wage, advocated dismantling the state’s online insurance market Kynect, and posited restructuring the Medicaid expansion. And yet Bevin’s largest amount of support came from the most impoverished areas of the state which have high numbers of Medicaid recipients.

Polls consistently had Conway ahead of Bevin throughout the race, and yet Bevin defeated Conway by nearly nine percentage points. Political experts have suggested several reasons for how this happened, such as low interest among Democratic voters and conservatives being less likely to participate in polls.

Another likely reason is that religious conservatives, which make up a huge voting community in Kentucky, were motivated by the situation surrounding Rowan County Clerk Kim Davis.

The escapade involving Davis and her refusal to issue marriage licenses in wake of the U.S. Supreme Court’s decision to legalize same-sex marriage received national attention, and Bevin showed support for Davis’ cause, turning a relatively insignificant issue into a culture war issue on which many conservatives base their votes.

Bevin’s victory should serve as a wakeup call to those on the left and even the center. The Democratic base was not motivated in this election, and the party paid the ultimate political price on Election Day. Regardless of whether or not they are justified in their sentiment, much of working class America is angry, and Republicans have proven to be more capable of capitalizing on the emotions of the citizenry and turning them into victories.

Cheyene Miller is the managing editor of the Kentucky Kernel, for which he wrote this column. It also appears at http://kykernel.com/2015/11/19/kentuckians-voted-against-their-own-interests/.

Here are the candidates' positions on several issues

This post may be updated with summaries of other issues.

ECONOMY
     Democrat Jack Conway and Republican Matt Bevin's economic positions adhere in large part to party orthodoxies. Bevin plans to make the Bluegrass more competitive by passing "right to work" legislation, which would outlaw labor contracts that require workers to pay union dues or fees. Conway's plan to bring more jobs to Kentucky primarily focuses on education. He plans to align job-training programs to the needs of employers and plans to work with schools to improve graduation rates. Conway wants an increase in the minimum wage to $10.10 an hour. Bevin opposes that idea, and his running mate, Jenean Hampton, said an increase to minimum wage would be "disastrous." Independent Drew Curtis favors the increase and says he will look at policies in other states and bring the successful ones to Kentucky, hoping to bring a "tech boom" to the Bluegrass by focusing on technology training. –Ben Johnson

EDUCATION

     Republican Matt Bevin says Kentucky needs to back out of the nationally adopted State Common Core Standards because they “doesn’t adequately address the diverse needs” of the state. Bevin also wants to guarantee school choice, including charter schools and tax credits for private education, and has said families who home-school their children should have access to the same public amenities provided to kids who attend state-funded schools. He favors outcomes-based funding for higher education, with emphasis on producing degrees that will help the economy.

     Democrat Jack Conway wants to expand early childhood education, first to 3- and 4-year-olds in homes with incomes up to 138 percent of the poverty level, with a goal of 200 percent. He supports Common Core and opposes charter schools and tax credits for private education. He says he would look at outcomes-based funding but wants to maintain a level playing field for universities.

     Independent Drew Curtis wants to expand early-college programs in high schools and says a budget cut to education is one of the last things he would recommend. However, he also says solving Kentucky’s pension problem is one of his first priorities, so education funding issues would have to wait at least a year. –Kevin Erpenbeck

DRUGS

     Drug abuse is a growing problem for Kentucky, which has the nation’s third highest death rate from drug overdoses.  The number of heroin overdoses has tripled in the last three years alone. There are limited treatment options available, with only one-tenth of the treatment beds needed. Here is how the three candidates for governor say they will deal with that problem:

     Democrat Jack Conway notes his history of fighting drugs as attorney general. He supports the local-option needle exchange program and calls for more education and treatment but has yet to provide a solution on how he will pay for that. He opposes legalizing marijuana for medical purposes and says people on Medicaid should be tested for drugs only with probable cause.

     Republican Matt Bevin says he would randomly drug-test Medicaid recipients but otherwise has talked less about the state’s drug abuse crisis than Conway. He says the key is intervening earlier and creating better economic opportunity. He says the state spends too little on behavioral health and supports legalizing marijuana for medical purposes.

     Independent candidate Drew Curtis supports decriminalizing addiction. He suggests copying Massachusetts’ program on tackling opiate addiction if it proves successful. –Megan Ingros

GAMBLING

     Expanded gambling, an issue that could have an impact on the state’s economy budget, is viewed with differently by all three candidates but isn’t a strong point of focus for any of them.

     Democrat Jack Conway favors a referendum on the issue and says the time could be right for it, to create revenue for the horse racing industry, pensions and early childhood education, since bond-rating agencies have said the state needs a dedicated revenue stream to shore up its pensions.

     Republican Matt Bevin stands on the opposite end of the spectrum. During an Oct. 6 debate, he rejected gambling as a possible solution to any of Kentucky’s problems. “I don’t think it’s the solution to what ails us financially in this state,” he said.

     Independent candidate Drew Curtis stands right in the middle. While not much more enthralled by the idea of expanded gambling than Bevin, he hasn’t been willing to completely dismiss it just yet. “Our pension system is in dire shape, so we must consider all options,” Curtis told WFPL Radio. –Jerry Seale

HEALTH CARE AND INSURANCE

     In regard to Medicaid, the federal-and-state-funded health insurance for lower-income people, Democrat Jack Conway wants to stay where we are right now and Republican Matt Bevin does not.

     Conway wants to keep the Kynect health-insurance marketplace and the expansion of Medicaid to people with incomes up to 138 percent of the federal poverty line, saying he believes the state-funded study that shows the expansion is paying for itself by adding so many people to the health-care system that enough jobs and tax revenue will be created to cover the state’s cost – starting at 5 percent in 2017 and rising to the federal health reform law’s limit of 10 percent in 2020.

     Bevin scoffs at the study, saying the expansion is unsustainable, and says he would apply for a federal waiver to change it to a program in which some people pay premiums, co-payments, deductibles or health savings accounts. He also wants to use the federal exchange and abolish Kynect, which is funded by a 1 percent fee on all health-insurance policies sold in the state. The federal exchange charges 3.5 percent on policies it sells.

     Independent candidate Drew Curtis is against abolishing Kynect and wants to stand and watch what happens with the Medicaid expansion. He says it seems likely to pay for itself in the near term. –Lauren Allen

SMOKING BAN
     Democrat Jack Conway favors a statewide ban on smoking in public places. Republican Matt Bevin says local communities should decide the issue for themselves. Independent candidate Drew Curtis favors a ban that exempts cigar bars and other establishments related to smoking. –Al Cross

TAXES
     Republican Matt Bevin calls for comprehensive tax reform that includes reduced income-tax rates on businesses and individuals and repeal of inheritance and inventory taxes.
     Democrat Jack Conway endorses bipartisan tax reform that would not increase overall revenue. He has called for ending the inventory tax.
     Independent Drew Curtis wants to change income-tax brackets to percentages of income, not dollar amounts, to adjust to inflation, and supports "an across-the-board reduction in exemptions, with the goal to elimimnate as many as possible over the next decade." –Al Cross 

Candidates make misstatements and questionable assertions in televised debate

By Al Cross
Kentucky Health News

Many of the questionable assertions and outright misstatements in Sunday night's debate for governor were about health care. Here's a fact check:

Conway said he had cut his budget as attorney general by 40 percent. Bevin said that was a lie because the legislature writes the budget. The governor receives budget requests from agencies and proposes a budget to the legislature, which passes it.

Bevin said Conway lied when he said Bevin would kick half a million people off health care. Bevin said in February that he would immediately end Gov. Steve Beshear's expansion of the Medicaid program. He has since denied saying that, and said last night that Democratic videos of his quotes omit the question he was asked, but that is not the case with his February quote. He now says he would seek a federal waiver to change the program. It might be argued that he could issue another executive order to replace Beshear's, but the Medicaid program has certain requirements that must be met unless waived, and waivers are not available immediately. While Bevin has been vague about his Medicaid plans, he has made clear for the last three months that his actions would not be as abrupt as he first said they would be.

Conway said the Kynect health-insurance exchange, which Bevin wants to abolish, is three and a half times more efficient than the federal exchange, to which policyholders would go. Bevin said that is "an absolute falsehood" because Kynect is funded by a 1 percent fee on all health-insurance policies in Kentucky and only 2 percent of the policies are bought through Kynect. Conway said afterward that he was referring to the 3.5 percent fee charged by the federal exchange, which would make those policies more expensive. While the term "efficient" could arguably be applied to the cost of those policies, a more common interpretation of Conway's comment would be that he was talking about Kynect's operating efficiency.

Bevin said the Kentucky Health Cooperative, a non-profit health insurer that is closing due to losses and lack of money, was "a distinct part" of the study that predicted the Medicaid expansion would pay for itself until 2020. The cooperative is not mentioned in the study. Bevin said afterward that the co-op was part of the "inputs" considered by the study. Reminded that the issue was the sustainabilty of the Medicaid expansion, Bevin noted the 51,000 co-op policyholders who will be losing their coverage. Reminded that Kynect has seven other insurers they can select from, Bevin asked, "Where are those taxpayers dollars going to go?" He was reminded that the co-op was funded by federal dollars, and "Those are our dollars." Bevin is running for governor, not president, but he is trying to appeal to people who dislike the entire "Obamacare' system. He appears to be using the co-op's failure to suggest that the system is not sustainable. However, the co-op, Kynect and the Medicaid expansion operate separately and are separately funded.

Conway quoted Bevin as saying that early childhood education, Conway's main issue, "serves no purpose." Bevin said was "another of those Democrat lies" because his full quote was that it serves no purpose after the third grade. That is based on a study that showed the effects of Head Start disappear after the third grade. Head Start is not the same as the early-childhood education program advocated by Conway, but Bevin has equated the two in the past.

Bevin said the state does not have the surplus that Conway mentioned because it has "tens of billions of dollars in unfunded liabilities." He was referring to state pension funds, which get annual appropriations from the budget but are financially separate. Budgets are for two years and the unfunded liability is for projected payments for current employees for the rest of their lives.

Bevin said, "It's a false idea that coal jobs can't come back." He noted that world coal demand has never been higher, but that ignores the facts that many electric plants in the U.S. have abandoned coal for cheaper natural gas and the coal in Central Appalachia is by far the most expensive to mine in the U.S. The Kentucky part of that coalfield has lost half its coal jobs in the last three years.

Fate of health coverage through Medicaid expansion and Kynect could rest on the outcome of the election

By Cheyene Miller and Anthony Pendleton

University of Kentucky School of Journalism and Telecommunications

            The fate of health coverage for about half a million Kentuckians could rest on the outcome of the Nov. 3 election for governor. Democrat Jack Conway wants to stick with the state’s embrace of federal health reform while Republican Matt Bevin does not.

            Gov. Steve Beshear expanded the Medicaid program and created an online insurance market known as Kynect. Between the 400,000 in the expansion and 100,000 private insurance plans purchased on Kynect, the percentage of people without health insurance dropped more in Kentucky than any state in the nation, from more than 20 percent to just over 9 percent, according to the Gallup Poll.

            Kentucky was the only Southern state to create its own insurance exchange, and one of only two Southern states to expand Medicaid, along with Arkansas.

Beshear is on his way out of the governor’s mansion, however, and his possible successors have two drastically different stances on the Patient Protection and Affordable Care Act, also known as Obamacare.

Conway’s stance throughout the race has been to keep what is arguably one of the greatest accomplishments of his fellow Democrat, while Bevin has promised to dismantle Obamacare in Kentucky, albeit with an inconsistent stance on the Medicaid expansion.

Bevin told reporters in February that he would immediately end the expansion, but in July he denied saying that and started talking about seeking a federal waiver to receive Medicaid money in a grant and create a system resembling Indiana’s, in which Medicaid beneficiaries pay premiums to get better benefits.

“We can’t afford the current structure as it exists,” Bevin said in September. Beshear questioned Bevin’s knowledge of the system, and said the non-partisan Congressional Budget Office found that such waiver plans “will likely cost more than the expansion as we have implemented it in Kentucky.”

Bevin has said a waiver might allow Medicaid to offer some help to people with incomes above 138 percent of the federal poverty level, perhaps by helping them with health savings accounts.

Before the expansion, only Kentuckians with household incomes at or below 69 percent of the federal poverty level qualified for Medicaid. The expansion doubled that to 138 percent of poverty.

The federal government is paying the full cost of the expansion through 2016, at which point Kentucky would start paying 5 percent of the cost, rising in yearly steps to the law’s limit of 10 percent in 2020. By the 2020-21 fiscal year, the expansion is expected to cost the state $363 million a year.

A state-funded study by Deloitte Consulting predicted in February that the expansion will generate enough jobs and tax revenue to pay for itself through 2020, but Bevin has called the study “nonsense.” Conway has cited the study in saying he supports the expansion but would monitor its costs.

In his speech at the Fancy Farm Picnic in August, Conway said Kentuckians should vote for a candidate who “understands that the truly Christian thing to do is to say that we are our brother’s keeper and health care for our people makes us a healthier and better society.”

            The candidates are playing to their bases Bevin by taking a stance against Kynect and the Medicaid expansion, and Conway by following the footsteps of Beshear in supporting it, University of Kentucky political science professor Stephen Voss said.

“They’ve already managed, without saying very much, to give that basic signaling that each side wanted to hear from them,” said Voss, adding that both candidates are also doing their best to remain vague when discussing health care: “For both candidates, delving more deeply into the specifics is fraught with risk.”

Bevin has been more consistent with his stance on Kynect, saying he would "facilitate the transition of enrollees" onto the federal exchange as he dismantles Kynect. In September, Bevin said he would consider a suggestion from Republican state Sen. Ralph Alvarado to keep Kynect operating and finance it by expanding it to other states, but he was skeptical of the idea.

            Lexington-based litigation attorney Douglas McSwain, who specializes in constitutional and health-care law, said Kynect is one of the reform law’s biggest success stories nationwide. “The main issue is that health-care reform has been a very good success under the Beshear administration,” McSwain said.

Kynect is funded by a 1 percent assessment on all Kentucky health-insurance policies, while the federal fee is 3.5 percent on policies sold on the exchange.

Independent candidate Drew Curtis has said the state can probably afford the first round of expenses from the Medicaid expansion, and should leave it and Kynect “alone as it is” until the state sees the long-term effects. “You can’t drop a massive system change on people, and (then) do it again in two years,” he said.

Kynect Director Carrie Banahan has said that Kynect would cost at least $23 million to dismantle and that most of the seven insurance companies using it would probably not go to the federal exchange.

            Whoever is elected governor will likely have many obstacles on his plate regarding health care, since Kentucky is one of the least healthy states. According to America’s Health Rankings, Kentucky is 47th in overall health, with major issues facing the state including high rates of smoking and preventable hospitalizations. Kentucky also ranks first in the nation for lung cancer deaths, according to the federal Centers for Disease Control and Prevention.

Cheyene Miller and Anthony Pendleton are journalism seniors at the University of Kentucky. They wrote this story for the Covering the Governor’s Race course being taught by Associate Professor Al Cross and Journalist in Residence John Winn Miller.

In a quiet race, gay marriage steals the focus from other issues; first debate with all 3 candidates is Tuesday night

By Matt Young
University of Kentucky School of Journalism and Telecommunications

In 2004 Kentucky voters passed by a 3-1 margin a state constitutional amendment defining marriage to be between one man and one woman. You’d be forgiven for assuming the initiative was on the ballot again this year.

The governor's race between Republican businessman Matt Bevin and Democratic Attorney General Jack Conway has been conspicuously quiet. “People like to know their governor, and I don't think either of these guys have done that with the people of Kentucky yet,” House Speaker Greg Stumbo told cn|2’s Pure Politics.

The lack of focus on the Nov. 3 election has left Rowan County Clerk Kim Davis to fill the attention the news media and voters.

Bevin called a federal judge’s jailing of Davis for defying his order to issue marriage licenses “utterly ridiculous,” saying that there is no need to jail someone for First Amendment beliefs, and called on Conway and Democratic Gov. Steve Beshear to take action to remove clerks’ names from marriage licenses. They said the law doesn’t allow them to do that.

Conway has exercised caution, waiting until after Davis was jailed to make his first comment. He said on Twitter, "I understand that passions are high on both sides of this issue, but we are nation of laws and no one can defy an order from a federal judge."

Asked by the county attorney to appoint a special prosecutor to look into an official-misconduct cases against Davis, Conway first did not respond. After Davis was released on condition that she not interfere with her deputy clerks’ issuance of marriage licenses, Conway said he would not name a special prosecutor because the matter was in federal court.

Conway has been largely mute lately, as he concentrates on raising money and wondering how much personal wealth Bevin will put into the race. His public appearances and media outreach have been almost non-existent since the Aug. 1 Fancy Farm Picnic.

Traditionally the governor’s race heats up after the Labor Day weekend, with a more intense schedule of debates and forums. Conway and Bevin will have their first face-off with independent candidate Drew Curtis at Bellarmine University in Louisville at 7 p.m. Tuesday, Sept. 15. The debate will be televised on Louisville’s WHAS-11 and Lexington’s WKYT-27; it is sponsored by the stations and their newspaper partners in the Bluegrass Poll, The Courier-Journal and the Lexington Herald-Leader.

The latest Bluegrass Poll, taken in late July, showed Conway leading Bevin 43 to 38 percent, with an error margin of plus or minus 3.7 percentage points (which applies to both numbers). Curtis had 8 percent.

Each side has turned up the rhetorical volume, with new TV ads.

Americans for Prosperity, a ”super PAC” supported by the Koch Brothers of Wichita, is attacking Conway for his support of federal health reform, or “Obamacare,” which it blamed for "a crisis in our hospitals” and “skyrocketing” insurance premiums.

The Kentucky Hospital Association says Obamacare has been a small part of its problems, but worries about future impacts. A national analysis by the National Conference of State Legislatures found that the average premium increase from 2014 to 2015 was effectively zero, while premium increases in the last decade have averaged about 10 percent. Kentucky rate increases for 2016 range from a 25 percent increase by the Kentucky Health Cooperative, which has sold most of the policies on the state’s Kynect insurance exchange, to an 11 percent decrease from WellCare. Other increases are between 5.2 and 12.2 percent.

The Republican Governors Association has been attacking Conway along the same lines, while Bevin hasn’t run ads of his own. Conway’s first attack ad builds on the “East Coast con-man” moniker that U.S. Sen. Mitch McConnell applied to Bevin last year in their primary battle.

The ad shows Bevin making statements on the campaign trail, then apparently walking them back. It starts out showing Bevin saying, “I was opposed to the Farm Bill because it was an insult to farmers.” The screen then splits and shows him saying that that was “a misrepresentation of what he said.” He has a case; he objected to the bill’s spending for non-farm programs (most of its funds are for nutrition) and the money it funneled to big agribusiness.

The ad gets right that Bevin has backtracked on his opposition to the Medicaid expansion in Kentucky. He initially said that he would end it, but now says he would scale it back.

Beneath the fray is Curtis, CEO of Fark.com. Without the big money that comes with a party nomination, Curtis has been unable to air TV ads, but being an independent underdog comes with its advantages; he can ignore partisanship, and be free to talk about the issues. Curtis has released the most detailed plan to address the state’s underfunded pension system.

As the race heats up expect all three candidates to address other important issues. There will be sparring over the tax code, and how to create additional revenue the state needs; education, including the Common Core standards; and “right to work” legislation, which forbids employers from requiring union membership as a condition of employment.

However, if this summer can be used as a crystal ball for the fall, expect Bevin to continue his defense of Davis, and Conway’s refusal to appeal the gay-marriage ruling that was upheld by the U.S. Supreme Court. State law allowed Conway to do that, but Bevin accuses him of hypocrisy.