TOMORROW: 400,000 Kentuckians will be kicked off Medicaid if GOP candidate wins.

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:

The only thing I'll add to this is that yes, the Democratic candidate, Jack Conway, does support KEEPING Medicaid expansion. While I have some issues with Conway on other subjects, when it comes to Medicaid expansion, he supports it...although I've gotta admit, when you look for "Medicaid" on his campaign site, all that comes up is his record on protecting Medicaid recipients from fraud/abuse as Attorney General...and there's no mention of Kynect at all. However, he has publicly stated in debates/etc. that he supports keeping both:

Conway, a Democrat, said if elected he will continue the expansion of Medicaid and state-run exchange, saying Kentuckians get better rates through Kynect than on the federal exchange.

“It’s a cheaper, more efficient way to allow people to purchase health insurance,” Conway said.

I should also note that there is a viable independent candidate, founder Drew Curtis, who has this to say about Kynect and Medicaid expansion:

Kentucky will have to start paying for some of the costs of Medicaid expansion in 2017. We can probably afford picking up 5 percent of the costs then, but maybe not when it increases to 10 percent in 2020. A Deloite study on the issue indicates that revenues from an increase in healthcare activity will cover Kentucky’s contribution. I’ll keep an eye on this just in case that doesn’t work out.

I would like to call in experts in operations and systems design to do an audit of how KYNect currently functions and see what can be improved. I would also open a dialogue with both healthcare professionals and patients to collect information on how well the system is serving both groups. In the start-up world we call this Customer Development: Before you create a product, see if anyone wants it. Luckily, Customer Development is effective even after you’ve started production.

I am against repealing KYNect at this time. For one thing, nobody has a proposal for a better replacement. Additionally, health care service providers just spent millions of dollars upgrading their computer systems and training their employees to accommodate KYNect. Let’s give them a break for a few years before ordering another massive overhaul. This will also give us time to evaluate how well KYNect works vs. solutions that other states may come up with.

In addition to the devastation of losing Medicaid expansion, it would also be a damned shame if the state-run kynect exchange were to be wiped out; this is one of the few exchanges which has actually been operating properly since the beginning. Unlike most of the other websites, kynect has been quietly chugging along, doing it's job for two years straight. There's no reason to shut it down, although doing so wouldn't be that terrible in practice, as KY would just join Oregon, Nevada and Hawaii in moving to the federal exchange next year.