Obamacare in the Ballot Box: Quick Take on Kentucky Governor’s Race from California

Heading into last Tuesday’s mid-term election, there was plenty at stake for the future of health reform (HBO’s John Oliver tried to warn us), particularly in states that have refused or have yet to decide whether to implement the optional Medicaid expansion—or had decided, like Kentucky, to opt in, not because the political winds were blowing in that direction, but thanks to Governor Steve Beshear’s bold executive order.

In view of Kentucky’s many successes on the ACA—the second largest drop in uninsured residents, a robust state-based exchange, and its distinction as the only southeastern state to opt in to Medicaid expansion—Tea Party Republican Matt Bevin’s gubernatorial win last Tuesday on an anti-Obamacare, anti-Medicaid expansion platform came as something of a shock, if not a wake-up call for what may be at stake for Obamacare in 2016.

In a recent Health Affairs blog, David Jones provides helpful perspective on the Bevin victory—it will likely embolden and fan the flames of the anti-Obamacare candidates, no doubt, but these candidates will be hard pressed to take away affordable benefits from the millions of Americans who would otherwise find themselves uninsured today.

We don’t want to downplay what is at stake for Affordable Care Act in 2016. Nor, like Jones, do we want to rush to judgment on the significance of Bevin’s victory. But we would rather “fan the sparks of hope” for the future of the ACA from across the nation.

Looking ahead to 2016, we see even in the battleground states, polling shows likely voters agreeing the ACA is here to stay and preferring candidates who are prepared to improve on, rather than scrap the law.

For states like California that are taking Obamacare as far as it can go or using it as a jumping off point for additional reforms, there is a story to tell on the national stage.

Evidence suggests that “active purchaser” or stronger authority over rates translates to lower premiums and slower growth in rates from one year to the next. And now California is taking that authority further to re-align incentives for higher quality, cost-effective care in time for the 2017 plan designs. If successful, such efforts will go to the heart of the issues Obamacare’s most vitriolic opponents care about most, or so they say: bending the cost curve. Why would you expand Medicaid, say leaders in Utah and Alabama, for example, when the program is so broken? And so we find these states up to their ears in delivery system reforms or Medicaid waivers of questionable intent, but with little to show for such efforts to date.

If even in the worst possible scenario, Kentucky’s reforms come unraveled under a Bevin administration, California will be here to show how Obamacare can be a jumping off point for reforms addressing access, quality, and cost. Instead of resting on the laurels of our own favorable polling on the ACA, we should bring the full story of California’s success forward in 2016.

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