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Kentucky: Good News! Matt Bevin too incompetent to carry out his terrible campaign promises!

I wrote a lot about Matt Bevin during the Kentucky gubernatorial campaign last fall, as well as after he won the election, was sworn in as governor, and started doing his best to screw up stuff which wasn't broken. As you'll recall, when it came to the Affordable Care Act and the state ACA exchange (kynect), Bevin originally promised that he was going to kill the kynect exchange completely (even though there's no reason to do so, it's been operating smoothly for years and has excellent branding in the state) as well as killing the ACA Medicaid expansion (even though, again, it's been a huge success in the state at no cost to them so far and only pennies on the dollar going forward).

Well, as Jeffrey Young notes over at the Huffington Post, it turns out that Bevin can't even screw over hundreds of thousands of people properly:

Kentucky has turned into the place where Obamacare repeal rhetoric meets Obamacare repeal reality. Reality is winning.

Gov. Matt Bevin (R) made his name in Bluegrass State politics as a tea party outsider, and throwing out the Affordable Care Act was one of his most common refrains. He used it first during his unsuccessful primary challenge against Sen. Mitch McConnell, now majority leader, in 2014, and then in his winning bid for the top position in the state last year.

But a funny thing happened on the way to the governor's office: Bevin's anti-Obamacare rhetoric started to tone down as Election Day approached. And in the months since he's been chief executive of Kentucky, instead of ripping up Obamacare out of his state, Bevin is making alterations to how the law works there and leaving its core elements and benefits in place.

A candidate who vowed to completely roll back Kentucky's expansion of Medicaid to more than 300,000 poor residents under the Affordable Care Act now is a governor who plans to put some conservative window dressing on the program, akin to what Gov. Mike Pence (R) did in Indiana. And rather than totally eradicate the state's health insurance exchange, Kynect, Bevin now plans to leave big parts of it in place even while sending its more than 100,000 customers toHealthCare.gov to buy their coverage instead.

This is great news on both counts, of course, although it still amounts to complicating/bogging down both programs in ways which make them less efficient and more of a pain in the ass in terms of paperwork and bureaucracy, but whatever.

Of course, as Young goes on to note, this isn't just about Matt Bevin being utterly incapable (thank God!) of keeping his campaign promises; it's about a larger truth:

Bevin seems to have learned firsthand that it was impossible to snap his fingers and make all that go away without upsetting a lot of people.

...For all the bluster about Obamacare in Congress and on the campaign trail -- plus the many, many repeal votes -- state-level Republicans have had more opportunity to actually disrupt the Affordable Care Act....But undoing Obamacare benefits that already exist is another matter entirely.

In other words, even if they manage to run a clean sweep of the White House, Senate and House this November, full repeal of the ACA is unlikely to happen in spite of the 60+ votes which Republicans have taken already to do just that. This doesn't mean that they won't make it worse by refusing to improve the trouble spots and damaging the parts that are working well (just as Bevin is doing), but I guess I can take some comfort in the knowledge that they're unlikely to rip it out "root and branch" as Mitch McConnell is so fond of saying.

Oh, one other thing: For quite awhile now I've been wondering whether "killing" kynect would mean completely wiping out the state exchange and moving to the federal one to fully join most of the states (a "Federally Facilitated Marketplace", or FFM) or if it means switching to a "Federally-Supported State Based Marketplace" (FF-SBM). It seems that, again, Bevin is backing down:

...And even though the Kynect brand name and website are being made sacrifices at the altar of anti-Obamacarism, Kentucky will continue to have a health insurance exchange that oversees insurers and handles other functions, following a model already adopted by Hawaii, New Mexico, Nevada and Oregon.

The link in Young's piece goes here:

Republican Gov. Matt Bevin appears to have found a way to abolish the Kynecthealth-insurance exchange without chasing away insurance companies or causing them to limit their offerings – and at just over 1 percent of the cost estimate used by his Democratic predecessor. But he isn't eliminating the insurance fee that funds Kynect.

Bevin and Health Secretary Vickie Yates Brown Glisson emphasized the much lower costs – which they said would be a net $240,000 for information-technology changes, compared to the $23 million estimated last summer byDeloitte Consulting, the state contractor who built the exchange.

This strikes me as being nonsense math, but the larger point is that instead of completely shutting down kynect, Bevin has apparently agreed to simply "pull an Oregon" and shift the technology portion of the exchange over to HealthCare.Gov, keeping the actual legal "state-based exchange" entity as it is:

Since federal health reform was fully implemented in 2014, more insurance companies have joined the exchange and offered policies across wider areas. Kynect Director Carrie Banahan warned last summer that if the exchange were closed, some of its insurers might not use the HealthCare.gov federal exchange.

Glisson told a legislative committee that the federal exchange will be used for insurance enrollment, but as part of a "supported state-based marketplace," which will still be run by the state. That will please insurance companies, which are state-regulated and have always wanted a state-based exchange.

...For the new marketplace, the federal government will handle consumers' eligibility appeals but the state will handle insurance-company grievances and still review insurance plans. Certification of the plans will move to the federal government, but it will "strongly rely" on state recommendations, Glisson told the panel. Consumer grievances will be handled by a state-federal partnership.

The thing is, there's a major difference between the states which have gone this route already (Oregon, Nevada and Hawaii): In all three of those cases, the existing state exchange website utterly sucked and was basically deemed unfixable. A fourth state, New Mexico, never moved off of HC.gov in the first place, so there was nothing to change.

In the case of Kentucky, however, the state technology platform/website has been operating smoothly since Day One. There's absolutely no technological or logistical reason to get rid of it.

In other words, they're gonna go through a whole lot of fuss and bother for absolutely no reason...not even to save the state residents any money, really:

The fee for using the federal exchange will be 1.5 percent, plus a proposed 0.5 percent state fee to cover outreach and plan-management functions. The state will have a "hotline" to provide basic information to consumers, and a call center for people on the federal-state Medicaid program.

As you'll recall, at the moment, Kynect is funded as follows:

  • Currently, kynect's $28 million annual budget is covered by a 1% fee charged to all premiums for everyone on individual policies (on or off exchange), small group policies and large group policies.
  • Kentucky has roughly 4.4 million people. Of these, around 9% are still uninsured, 27% are on Medicaid (much of this thanks to ACA expansion!) and at least 18% are on Medicare (800K as of 2012, more today). That means thatno more than 46% of the state's population is currently paying this 1% fee; it's likely around 40% doing so.
  • In other words, right now, as far as I can tell, around 1.8 million Kentuckians are paying roughly $16 per year to pay for Kynect.

If I'm reading the "FF-SBE" fee structure correctly, it would amount to a 2% fee, but charged to fewer people. The actual total dollar amount generated may end up being higher or lower than it is now, but the bottom line is that it's a lot of shuffling things around for no particular reason other than to save face for Bevin by making it look like he "killed Obamacare" in the state, which is of course nonsense.

Just like Marco Rubio with the Risk Corridor Massacre, Kentucky Governor Matt Bevin hasn't "killed Obamacare", he's just made life more difficult for a lot of people...for no particular reason.