Kentucky is one of the poorest states in the union. It vies with West Virginia and Mississippi for bottom place in any well-being list. Its rates of poverty, obesity and general ill-health are among the worst in the country. It has high unemployment. And residents of Kentucky are among the most miserable in the nation, attributable in part to the high incidence of poor health.
In the 30 years he has served it as a United States senator, Republican Mitch McConnell, who is up for re-election this year, has provided little substantive help to the state. Oh sure McConnell steered a good chunk of earmark money to Kentucky over the years; but, as this Huffington Post profile on his career found, the money was directed scattershot fashion primarily in ways that would best cement McConnell’s own power and support in the state rather than as part of any strategy to enhance the state’s welfare. And since 2011 the earmark well has dried up, banned by McConnell’s own party in a largely symbolic show of fiscal rectitude.
Thanks to its Democratic governor’s wholehearted embrace of the Affordable Care Act, however, Kentucky stands to benefit enormously. Already about 360,000 people have signed up for health insurance under the ACA, of whom 75% were previously uninsured. All but 20,000 of the new enrollees are covered under the ACA’s expanded Medicaid, thanks to Kentucky’s low median income level and high poverty rate.
There are few states whose residents need it more. As the 24/7 Wall Street summary of the Gallup-Healthways Well-Being Index 2014 noted:
Kentuckians had some of the most unhealthy behaviors last year. Less than 60% of those surveyed said they ate well all day, the worst among all states, while the smoking rate was the highest in the nation. Unhealthy habits in the state likely contributed to poor physical health. Respondents from Kentucky were among the most likely to complain about lack of energy and sleep, and nearly 30% said health issues prevented them from going about their normal lives. The state’s population was the nation’s most reliant on prescription drugs, with 19.3 prescriptions filled per capita in 2011, tied with West Virginia.
And since approximately 640,000 or 17.5% of residents under 65 lacked insurance prior to the ACA, the law may be a game changer for a state that has traditionally struggled. While there is as yet no clinically proven connection between health insurance and good health, research indicates that having insurance coverage at the very least relieves stress and depression by ameliorating the strain of financial insecurity. Over time it is not unreasonable to hope that the expansion of health coverage in Kentucky will have an enormously significant and positive impact on its population’s well-being.
One would think that this might change the political landscape in this very conservative state. After all a law passed by Democrats in Washington and implemented brilliantly in Kentucky by Democratic Governor Steve Beshear through a remarkably trouble-free website, is already benefitting scores of thousands and has reduced the rate of uninsured by over 40%.
Alas not so. Hatred for Obama and anything associated with him overshadows any actual benefit from the ACA. According to Yahoo News:
Far from being seen as a success story, though, in Kentucky, the health care law and Beshear’s strong embrace of it remain deeply controversial. A recent poll showed that a plurality of Kentuckians continue to favor repealing the law. Other than Beshear, many of the state’s leading Democrats, aware of the lingering tensions around the ACA, avoid speaking about it publicly, wary of being seen as too supportive of “Obamacare.”
Assuming McConnell survives a GOP primary challenge, his Democratic opponent in November will be Allison Lundergan Grimes. In a rational world, Grimes would be trumpeting the success of the ACA in Kentucky and its promise of a better future for so many. Instead:
Alison Lundergan Grimes, the Democrat challenging McConnell in a closely watched U.S. Senate race, does not include any mention of the law on her campaign website and has avoided associating herself with Beshear’s embrace of it.
The Economist wonders:
Why are Kentucky Democrats running away from a law that has for the first time brought free or affordable health insurance to hundreds of thousands of their constituents— mainly at the expense of wealthy out-of-staters? This is one of the poorest, unhealthiest, least-insured states in America, the state with the fourth-highest rate of Social Security disability status in the country, a state that is a byword for cancer-ridden smokers and black-lung-plagued coal miners. Why, among these voters especially, is Obamacare such a losing issue?
Because it was conceived and passed by Democrats and pushed by a black Democratic president, that’s why.
McConnell, of course, has nothing to offer Kentucky but his usual manipulations of the feeble-minded on issues like gun-control, and the promise to repeal a law that stands as the most positive development for the welfare of ordinary Kentuckians in a generation or more. Yet Grimes is a distinct underdog and current trends suggest that Democratic office holders will soon be rarer than unicorns in the state.
In his trenchant book, Thomas Frank asked the question: What’s the Matter With Kansas? People in Kentucky should be asking the same question of themselves.