Beshear, in D.C., speaks bluntly about state's health issues and 'rank politics' that keeps some states from expanding Medicaid

Beshear at the Brookings Insttitution

By Al Cross
Kentucky Health News

An interesting thing sometimes happens to governors when they travel to Washington; they speak a little more freely than they do in their states, and that appeared to be the case when Gov. Steve Beshear and Colorado Gov. John Hickenlooper, another Democrat, did an 85-minute interview at the Brookings Institution Friday, Feb. 20.

Asked to describe how he expanded Medicaid under federal health reform, Beshear said, "As you can imagine, the president is not popular in Kentucky. He’s got about a 30 percent approval rating, and if you mention Obamacare, the negative numbers skyrocket because the critics ran a very successful negative campaign against the whole idea of the health-care law, the Affordable Care Act.

"So I had to put all that politics up against the fact that Kentucky has some of the worst health rankings in the country, just like most Southern states. We’re too fat, we smoke too much, we eat the wrong stuff, we’re way up there in cancer, and you name it, and we don’t look good in it." He said the reform law was the "transformational tool" needed to attack Kentucky's health issues "in a systemic way."

Most Republican-controlled states have rejected Medicaid expansion, but several Republican governors did it and others are trying to do it. Beshear said he hoped they succeed "in spite of the fact that President Obama is the one that advocated for it, because that’s kind of crazy at this point, to just allow rank politics to interfere with the health of your people, just doesn’t make a hell of a lot of sense."

Beshear didn't mention that state law allowed him to expand Medicaid and create a health-insurance exchange without involving the legislature, especially the Republican-controlled Senate, but he alluded to the need to tread softly.

"Along came the Affordable Care Act, and as soon as it passed, Kentucky very quietly started taking every dollar we could get from the federal government to plan, and once the Supreme Court finally declared it constitutional, then we really hit the ground running."

When the exchange opened, "The pent-up demand was just amazing. I mean, people came out of the woodwork, wanting affordable health care," Beshear said. "The critics had moved from ‘It’s horrible, it’s terrible, it’ll never work’ – of course, it worked – they moved to, ‘Well, it may be good, but we can’t afford it.’ So I knew that at the end of the first year, I needed to address that, because we’ll have another budget coming up."

Beshear said his original projections, based on a PriceWaterhouse Coopers study, were "wrong," because they estimated fewer jobs and tax revenue would be generated than actually were in the first year, according to a Deloitte Consulting study he released this month.

"So now we’re at the point in Kentucky where, OK, it works; and nobody argues with the idea that people need affordable health care; and now we see we can pay for it; and so the only thing left to argue about is, ‘Are you gonna be against this because of the name of the guy who got it passed?’ And I think, I think everybody is coming to the realization that this is something that’s going to make a huge difference in Kentucky – over a generation."

Beshear noted the "thousands of people taking these preventive measures to take control of their own health. And that’s what we’re really after, educating people to take care of their own health, to keep them out of the emergency room, keep them out of the inpatient days in the hospital."

He said the first year offers hope for Appalachian Kentucky. "Our poorest areas economically are the most insured now because they’ve gone and they’ve signed up and I would hope in the next generation because we’re getting healthier you’re gonna see more jobs in that area," he said, discussing the desires of potential employers.

"While they love tax incentives, while they love good infrastructure, you know, all of these goodies that they can get, they will all agree on one thing, that their biggest and highest priority is a productive workforce. If they don’t have an educated, highly trained, drug-free workforce, then they can’t be successful. And guess what? You can’t have a productive workforce if it’s not a healthy workforce, if everybody’s off sick all the time, or if you’re having to stay home with your kids, you’re not at work and you’re not productive, so all of this really goes together. If you don’t improve people’s health, if you don’t improve their education, then you’re not going to have the kind of economy you’re going to need to move the state ahead."

The interview is available at http://www.brookings.edu/events/2015/02/20-good-governance-states-beshear-hickenlooper.