Whoever is elected governor of Kentucky on Tuesday will determine whether the state continues its expansion of Medicaid under the Affordable Care Act and maintains its insurance exchange, which has been praised as one of the most successful state-run marketplaces.
Recent polls show Democratic candidate Jack Conway, the state's attorney general, with a slight edge over Republican Matt Bevin, who has vowed he would reverse the Medicaid and exchange programs implemented under the leadership of current Democratic Gov. Steve Beshear.
The most recent Bluegrass Poll found Conway with a 5 percentage-point lead. Fifty-four percent of respondents said Medicaid expansion should continue, while just 24% said it should not.
Kentucky, which is ranked 47th among states for overall health by the United Health Foundation (a not-for-profit started by UnitedHealth Group), has seen its rate of uninsured decrease under the ACA more than almost any other state. It dropped from more than 20% in December 2013 to about 9% this June, according to Gallup.
Residents of the state, however, have largely opposed the administration of President Barack Obama and his signature healthcare reform package. Kentucky was one of the only red states to fully implement the ACA, mostly because of Beshear's actions.
The state received a blow earlier this month when its co-op health plan, Kentucky Health Cooperative, announced it would close by the end of the year. It was hardly alone, though. Ten of the country's 23 co-ops have tanked this year. Several of them blame lower than expected federal payments under an ACA program intended to mitigate losses for plans that suffer from high medical costs.
Bevin has walked back some on his statements about undoing the state's Medicaid expansion. He says he would not continue its current coverage parameters but would not kick people off the program.
Bevin said he would seek a waiver to alter the program and possibly implement one similar to Indiana's, in which beneficiaries pay premiums for coverage. He has also said he would abolish the state's health insurance exchange, called Kynect.
Conway has said he would continue Medicaid expansion in the state and keep Kynect, which he called a national model.
Susan Zepeda, president and CEO of Foundation for a Healthy Kentucky, said there is a lot hanging in the balance based on the widely divergent views the candidates have expressed . But, she added, it's not always easy to determine what a candidate would actually do based on statements during a campaign.
Emily Beauregard, executive director of Kentucky Voices for Health, said residents should have access to high quality care, regardless of who is in office, and people who are newly eligible for Medicaid have taken advantage of preventive services that are likely to improve their long-term health.
“Ensuring folks have coverage isn't where we end, but it's certainly where we begin,” Beauregard said.
The state-based exchange has also helped, she said, and its workers who help Kentuckians sign up for coverage (called kynectors) are helping them understand how to use their plans and where to get services.