In last night’s debate in a key Senate race, Senate Minority Leader Mitch McConnell, R-Ky., and his Democratic opponent, Alison Lundergan Grimes, both obfuscated on questions about President Obama’s healthcare law, underscoring how the politics of the law is changing as it continues to get implemented.
Obamacare remains broadly unpopular, but amid all the horror stories, there are also people benefitting from its expansion of insurance coverage through the exchanges and Medicaid. This has complicated the repeal message that has been standard fare for Republicans for four years. This is particularly true in Kentucky, which is a conservative state with a large low-income population that is eligible for insurance benefits through the law.
In May, a poll found that 57 percent of Kentuckians had an unfavorable view of Obamacare, compared with 33 percent who had a favorable view. However, by 29 percent to 22 percent, a small plurality had a favorable view of Kynect, the state-based exchange that was set up as the vehicle to deliver insurance through Obamacare.
In attempting to navigate this environment, McConnell has staked out a position that’s incoherent — arguing that he wants to wipe out the awful entity “Obamacare,” while trying to create the impression that it wouldn’t affect anybody’s benefits.
“Kentucky Kynect is a website,” McConnell said during the debate. “It was paid for by a $200 million some odd grant from the federal government. The website can continue. But my view the best interest of the country would be achieved by pulling out Obamacare root and branch.”
When listing the problems with Obamacare, all of McConnell’s arguments were based on the provisions that were intended to pay for the benefits — namely, its taxes and Medicare cuts. But he was much more evasive when it came to the benefit side.
“With regard to Kynect, it’s a state exchange,” he said. “They can continue it if they’d like to. They’ll have to pay for it, because the grant will be over. And with regard to the Medicaid expansion, that’s a state decision, states can decide whether or not to expand Medicaid or not. In our state, the governor decided to expand Medicaid.”
Asked again if he supported Kynect, McConnell said, “It’s fine, yeah. I think it’s fine to have a website, yeah.”
But in reality, if Obamacare were repealed “root and branch,” it wouldn’t just be website grant money that Kentucky would lose — it would be all the federal subsidies for individuals to purchase insurance through the exchange. And if the state decided to expand Medicaid without Obamacare, state taxpayers would have to pick up the bill, because they couldn’t rely on federal money.
McConnell didn’t argue that he has an alternative plan to address any loss of coverage that would result from repeal.
But Grimes wasn’t being forthright either. It’s popular to criticize Republicans for attacking Obamacare without offering an alternative. On the flip side, Grimes vowed to streamline and fix Obamacare, without offering a single workable suggestion for how she’d go about it.
“There’s work that we have to do to fix the Affordable Care Act, but we have to have a senator that actually realizes what the realities are here in Kentucky,” Grimes said.
She said that 500,000 residents of the state had benefitted from the law’s coverage provisions and said, “I will not be a senator that rips that insurance from their hand. I will work to fix the Affordable Care Act.”
When asked for a specific proposal, she said, “Extending the grandfathering clause. When Washington politicians make promises, ‘if you like your doctor and your plan you should be able to keep it,” we need to mean that, and that is the extension of the grandfathering clause.”
But that’s a bogus talking point. The “grandfathering clause” was a provision within Obamacare that said that certain plans that were in effect before the law passed would still be allowed to exist after, even if they didn’t comply with the new rules of Obamacare. Obama, under fire for a wave of plan cancellations last year, just announced that the administration wouldn’t enforce the law. But state regulators have discretion about whether to go along with this fix and insurance companies are not required to continue offering the same plans.
The problem is that simply expanding the law’s “grandfathering clause” wouldn’t get rid of the raft of regulations that are imposed on insurance policies. Because those consumers who were in the individual market before Obamacare are generally younger and healthier than the population on the exchanges, insurers were counting on those whose plans were cancelled (and who would then have to seek insurance on the exchanges) to improve the risk pool.
So, short of making larger changes to Obamacare’s regulatory structure, to have teeth, Congress would have to pass a law requiring insurers to maintain the same plans in perpetuity. And that would drive up premiums for everybody.
The reality is this. If Grimes is elected, she’d be a vote to leave Obamacare effectively unscathed. If McConnell is elected and he pushed to repeal Obamacare “root and branch,” Kentuckians who are currently benefitting from the law would lose their federally-subsidized benefits. If he wants to avoid this reality, he’ll either have to get behind some alternative, or abandon full repeal. Or he could stand up for limited government principles and argue that it isn’t the responsibility of the federal government to make sure everybody has health insurance.
