Canary in a Coal Mine

Why Kentucky’s new GOP governor will be a test case for Republicans across the country. 

Matt Bevin

Matt Bevin, Kentucky’s governor-elect, campaigning in Fountain Run, May 17, 2014.

Photo by Win McNamee/Getty Images

Businessman Matt Bevin’s surprisingly lopsided victory against Democratic Attorney General Jack Conway in Tuesday’s Kentucky gubernatorial race will tempt liberals to resort to one of their favorite dejected shoulder shrugs: that it’s another case of pesky voters acting against their own self-interest. It’s an oft-repeated line that’s irksome not just for its condescension but also its fatally flawed logic: Voting is a pretty clear expression of one’s self-interest, so it’s impossible, really, to vote against one’s self-interest. And last night a majority of Kentucky voters weighed the factors and found it in their net self-interest to vote for Bevin.

Kentucky is the latest Southern state during the Obama era to shed its decades-long Democratic dominance on the state level. As in Tennessee or Arkansas, voters whose families have been voting Democrat for state-level offices for generations are now aligning their state preferences with their federal ones. These are red states now, and the unpopularity of Barack Obama was enough to outweigh whatever unpopular policies Bevin supported.

One of the items that Kentucky voters determined was not as important to them as installing a Republican governor was the state’s successful, full implementation of the Affordable Care Act. Aside from the recent collapse of a state health insurance co-op, Kentucky’s relatively glitch-free state-run insurance exchange, Kynect, and acceptance of the law’s Medicaid expansion have been widely recognized successes. The state’s uninsured population dropped 40 percent between 2013 and 2014, according to Census figures released this fall, and the number has continued to plummet. The Kentucky Cabinet for Health and Families estimates that by now roughly 400,000 Kentuckians have taken advantage of the ACA’s Medicaid expansion, while another 100,000 have signed up for private insurance through Kynect.

What Bevin must now decide is the extent to which he’s willing to rescind coverage from the newly insured. Republicans on the federal level will be paying close attention. If he claws back insurance from people who vote Republican but also enjoy their health coverage, will he pay a significant political price?

Bevin’s gradual scale-back of his position to eliminate any and all traces of Obamacare from Kentucky soil suggests that Republican leaders, when faced with the prospect of actually doing what they’ve been promising to do since Obamacare was enacted, will back off. When Bevin was running to Sen. Mitch McConnell’s right, he was for total repeal of the law and hit McConnell for not pushing hard enough on that. Bevin moderated his opposition from full-scale obliteration of the law as he prepared to assume a governor’s office that, by nature of the way outgoing Democratic Gov. Steve Beshear implemented the ACA, has powerful discretion to dismantle it.

As Slate’s Jordan Weissmann writes, Bevin has pledged to trash the Kynect exchange and transfer the state’s insurance shoppers to a federal one. Several states have sent their customers to federally facilitated exchanges, but many of them did so because the exchanges they tried to set up turned out to be lemons. Kynect worked, so … what’s going on here? In any event, the bottom line is that Kentuckians will still be able to purchase individual coverage on exchanges.

The Medicaid expansion, from which the bulk of the ACA’s reductions in uninsured populations have come, is under much more risk. Up until recently Bevin was speaking quite clearly (in fundraising letters, at least) about his desire to repeal the state’s Medicaid expansion. He has since said that he plans to reject the Medicaid expansion Beshear accepted—in which Medicaid, the public program, is simply made available to more people—and would seek a federal waiver and grant money to implement a more customized, private plan–focused expansion similar to the one Arkansas pioneered. (The future of Arkansas’ expansion itself is in question. The state elected a Republican governor in the 2014 election who is still determining how to negotiate his right-wing campaign with the practicalities of governance.) For states that didn’t accept the Medicaid expansion at all in the beginning, moving to a more limited agreement is good for the uninsured. For states like Kentucky, though, that accepted the Medicaid expansion wholesale, moving toward a “customized” plan will inevitably cost some residents their insurance via stricter eligibility requirements.

Much of Kentucky’s shift toward Republican control stems from Democrats’ losses in the eastern, Appalachian part of the state, where poverty is high but coal is king. “Bevin pulled some of his best numbers in Kentucky’s impoverished eastern counties,” the Washington Post writes, “where enrollment had been highest.” The “tweaks” to the Medicaid expansion, as Bevin more recently has been terming them, will test Democrats’ belief that Republicans won’t actually follow through on their rhetoric about taking back coverage that’s already been granted because it would turn off beneficiaries who are culturally disposed to voting Republican. If Bevin undoes much of Kentucky’s ACA success story and his popularity collapses, those many Republican presidential candidates who’ve pledged to do away with Obamacare root and branch might take note. If he does so and it has no discernible effect on his support, though, Republicans will feel much more comfortable going after the law if they recover the White House in 2016.