When ass-half Matt Bevin was running for Kentucky Governor, he campaigned explicitly on wiping out the state's expansion of Medicaid to over 400,000 Kentuckians under the Affordable Care Act.

As election day actually approached, he began kind of, sort of walking this pledge back, making vague references to possibly shifting to some form of "waiver" version of Medicaid expansion, along the lines of several other states. These vary from fairly mild (small co-pays/nominal premium payments, as we have here in Michigan) to extremely confusing/complicated, as they have in Indiana:

"Sometimes I park in handicapped spaces
While handicapped people make handicapped faces."

--Denis Leary, "Asshole"

A couple of weeks ago I noted that newly inaugurated Republican Governor of Kentucky Matt Bevin was, true to his word during the campaign, making the destruction of kynect, the Bluegrass State's ACA healthcare exchange, one of his first and highest priorities.

Never mind that the exchange has (unlike most of the other ACA exchange sites) operated pretty much flawlessly since day one.

Never mind that thanks to the ACA and kynect, the uninsured rate in Kentucky has been slashed by more than half over the past two years, from over 20% down to 9%.

Never mind that the "kynect" branding has been an unprecedented and award-winning success.

As I noted last week, as of Monday, December 7th, here's the sort of information which could be found on outgoing Democratic Governor Steve Beshear's "Healthier Kentucky" webpage:

Open Enrollment stats as of Thursday 2/19/2015:

If you take a look at the State-by-State chart, you'll notice that in addition to a few clarifications here and there, there are 5 states (well, 4 states +DC) all the way at the bottom labelled "NO DATA YET".

California insists, just like last year, on doing this weird thing where they release the number of new enrollees who have signed up on a fairly regular basis, but the number of renewals by current enrollees is kept a secret all the way into January. I have no idea why they do that, and it's pretty important given that we're likely talking about somewhere between 1.0 - 1.3 million people here.

On the other hand, at least they've posted data on their new additions. DC, Idaho, Kentucky, New York and Vermont haven't even done that much as of this writing.

Unlike the exchange QHP enrollments, which will always continue to be the heart and soul of this website (it's right there in the name, after all), I've kind of gotten away from trying to track Medicaid expansion on a granular level over the past few months. The main reason for this is that in many of the expansion states, they've simply maxed out on enrollees, and the numbers from week to week or even month to month are simply holding steady at this point.

Here's what Democratic Kentucky Governor Steve Beshear's official "Healthier Kentucky" webpage looked like yesterday. Outdated, of course (no updates since the end of the 2015 Open Enrollment Period), but lots of data touting the thousands and thousands of people the Affordable Care Act (aka OBAMACARE, guys) has helped receive healthcare coverage via either private policies or Medicaid expansion:

In 1994, there was an episode of the acclaimed sci-fi TV series "Babylon 5" titled "Believers". Here's the basic plot synopsis:

Dr. Franklin faces an ethical dilemma when the parents of a dying child refuse to let him operate for religious reasons. Their son is suffering from a chronic respiratory ailment and will die soon. It can be cured with surgery; however their religion prohibits surgery (believing that cutting into a body will release the spirit, reducing the body to something worse than death—it is something only to be done to food animals). Franklin's associate Dr. Hernandez attacks their beliefs, but Franklin reprimands her, telling her that they have to work with the parents, not against them.

Over at the Washington Post, Amy Goldstein has a pretty good story about the Real People who are benefitting from the ACA in Kentucky...and those among them who voted for Republican Matt Bevin anyway:

Dennis Blackburn has this splintered self-interest. The 56-year-old mechanic hasn’t worked since he lost his job 18 months ago at a tire company that supplies a diminishing number of local coal mines. “The old guy had to go home,” Blackburn says of his layoff.

He has a hereditary liver disorder, numbness in his hands and legs, back pain from folding his 6-foot-1-inch frame into 29-inch mine shafts as a young man, plus an extra heartbeat — the likely vestige of having been struck by lightning 15 years ago in his tin-roofed farmhouse.

Unlike the federal exchange ( and many of the state-based exchanges which have experienced massive technical problems to some degree or another over the past two years (Oregon, Nevada and Hawaii have gone kaput; Massachusetts & Maryland had to be completely rebuilt; Vermonts is still iffy),  the Kentucky ACA exchange website, aka "kynect" (lower-case intentional), has been chugging along smoothly since Day One on October 1, 2013. It's fully self-sufficient, well known and trusted by Kentuckians, and has been an amazingly successful venture in general.

So naturally...

Speaking in his first public comments since he was elected governor of Kentucky on Tuesday, Matt Bevin repeated his pledge to dismantle kynect, the state’s health insurance exchange that has been hailed as a national model.

“My intent is to have it wound down by the end of next year,” Bevin said of the online service people use to shop for health coverage or determine whether they are eligible for Medicaid under the Affordable Care Act.

One of the arguments Kentucky Governor-elect Matt Bevin has made in favor of killing off the wildly successful, smoothly-operating kynect state-based ACA exchange has been that doing so would "save Kentucky money". The idea is that by shifting everything over to the federal exchange at HealthCare.Gov, the state of Kentucky would save the cost of operating their own exchange.

In one sense, this is true; kynect is currently supported by a flat 1% charge for all premiums on all individual policies sold in Kentucky, both "inside and outside of the marketplace." In other words. whether you enroll in a individual policy either via Kynect or directly through the insurance carrier, they're tacking on a 1% surcharge to your premiums to pay for the exchang to operate. So, yes, dropping kynect would also stop that 1% fee from being charged.

The population of Kentucky is just over 4.4 million people.

The number of Kentuckians enrolled in Medicaid specifically due to the Affordable Care Act's expansion provision is just over 400,000 people (418K to be precise, according to Emma Sandoe, who used to work for CMS).

By my math, that's a bit over 9% of the entire state's population which--assuming Republican Governor-elect Matt Bevin keeps his vow from the campaign--is about to be kicked off of Medicaid.

Wil Wheaton said it best: 

Oh, Kentucky. You really fucked up today.

— Wil Wheaton (@wilw) November 4, 2015

Ultimately, the blame lies with the voters for failing to care about their own interests, but I do want to say one thing about Democratic candidate Jack Conway's campaign.

I've mentioned tomorrow's Kentucky gubernatorial election, and the fact that Republican candidate Matt Bevin is not just a staunch opponent of the ACA (not exactly a shocker) but that he's repeatedly stated that if elected, he'd repeal the state's implementation of Medicaid expansion, which is currently providing healthcare coverage for about 400,000 people (around 350K enrolled in 2014, and another 50K or so this year).

However, I was a bit shocked this morning when I realized that I've only mentioned the KY race in passing via my "Short Cuts" link roundups.

With the election just one day away and my plate filled with other OE3-related stuff, I don't really have time to do a full write-up. Fortunately, John Oliver of Last Week Tonight has done an excellent job of explaining the whole situation (there's actually three state elections tomorrow where Medicaid expansion is theoretically an issue, but Kentucky is the only one where it's at risk of being taken away). Watch the whole thing:

Thanks to Zachary Tracer for the heads up.

The other day I wrote a general overview of the ACA "Risk Corridor" debacle.

The short version is that there were 3 funding programs put in place under the Affordable Care Act designed specifically to help smooth the waters and keep insurance carriers afloat for the first few years until they got past the bumpy transition period. One of these was called the "Risk Corridor" program. Basically, the carriers who lose their shirts the first 3 years were supposed to have at least a portion of their losses covered to tide them over; call it "training wheels" for the insurance industry. The funding was supposed to come partially from the other insurance companies which did better than expected...but any shortfall was supposed to be covered by the federal government, with the caveat that any surplus paid to the government stayed there as a type of profit.

A couple of days ago I noted that Covered California is adding a very good feature this year: They're opening up 2016 enrollment nearly 3 weeks early...for those who are already currently enrolled. Starting this monday, Oct. 12, current enrollees will be able to renew or switch to a different CoveredCA plan, 19 days ahead of he official Nov. 1st Open Enrollment launch.

Today I discovered that at least one other state-based exchange (Kynect, in Kentucky) is doing this as well...sort of:

I clicked through and saw this listed under the Frequently Asked Questions:

1. How do I enroll in kynect?
Simply visit or talk to your insurance agent. If your insurance plan is up for renewal, you may be eligible to enroll through kynect today. You can also call Customer Service at 1-855-4kynect (459-6328).

I was kind of hoping that this morning's Gallup uninsured rate news would include a monthly update for July; instead, it only runs through the end of June, the same quarterly survey results that they released a month ago. Then again, things probably didn't change much in July.

Instead, this time they've broken the numbers out by state:

WASHINGTON, D.C. -- Arkansas and Kentucky continue to have the sharpest reductions in their uninsured rates since the healthcare law took effect at the beginning of 2014. Oregon, Rhode Island and Washington join them as states that have at least a 10-percentage-point reduction in uninsured rates.