Politics & Government

In lawsuit over a Trump health initiative, Bevin, Beshear put Kentucky on both sides.

Beshear, Bevin give victory speeches after primary

Kentucky gubernatorial candidates Andy Beshear and Matt Bevin give their victory speeches after winning the 2019 primary for their parties.
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Kentucky gubernatorial candidates Andy Beshear and Matt Bevin give their victory speeches after winning the 2019 primary for their parties.

Kentucky Gov. Matt Bevin filed a brief in a federal court case last Friday, defending a Trump administration effort to expand Association Health Plans, which allow similar small businesses to band together and provide health insurance plans that are exempt from some of the protections of the Affordable Care Act

It was a turn-of-the screw legal filing in an appeal after a federal judge struck down the Trump administration’s initiative in March. The catch? It put Kentucky on both sides of the argument.

Attorney General Andy Beshear made Kentucky one of 11 states who filed the lawsuit to block the expansion of Association Health Plans — which the Labor Department says gives small businesses “more choice, more access and more coverage” and President Trump once said will “rescue Americans from Obamacare and the Obamacare nightmare.” The states claimed it was an effort to undercut the Affordable Care Act because the association health plans didn’t always have to provide coverage for “essential health benefits” like mental health care and coverage for prescription drugs.

By joining the lawsuit opposite Beshear, Bevin is highlighting one of the stark areas of contrast between the two political foes vying to lead the state this year: healthcare.

Beshear has attempted to make healthcare one of the key issues in the race, adopting the “healthcare is a right” platform that helped steer the Democrats to victory in the federal elections in 2018.

The issue has had little success in Kentucky. Despite Bevin’s pledge to end the Medicaid expansion in 2015, he won Owsley County, a place where 66 percent of the population is on Medicaid, with 70 percent of the vote. Democratic congressional candidate Amy McGrath built a campaign that included criticizing U.S. Rep. Andy Barr for voting to repeal the Affordable Care Act, only to lose the race.

Stephen Voss, a political science professor at the University of Kentucky, said voters tend not to vote on promises that candidates lay out in campaigns.

“Until there is pain, you wouldn’t expect voters to punish Bevin just for a stance he’s taken,” Voss said.

And there hasn’t been pain — yet.

After rising to office with his pledge to end Kentucky’s 2014 Medicaid expansion, Bevin quickly changed course to working within the system. He directed his Cabinet for Health and Family Services to draft a Medicaid waiver that allows the administration to require some people on Medicaid to work or volunteer and pay for some of their care.

The administration estimates that the waiver would result in around 95,000 of the 400,000 Kentuckians currently on Medicaid no longer being on the rolls.

The changes have yet to take effect. Twice, a federal judge denied Bevin’s Medicaid waiver that would allow the administration to require some people on Medicaid to work, volunteer and pay for some of their care. When the administration attempted to stop providing dental and vision coverage, the backlash was strong enough that they immediately backed off.

With few consequences to the waiver so far, Voss said the political debate reverts to the traditional stand-off between Republicans and Democrats.

“It becomes the usual ideological posturing between Democrats and Republicans,” Voss said. “It matters most to the politically sophisticated people but it usually doesn’t sway elections.”

The differences between Bevin and Beshear on healthcare have been well known to those who have been tuned into Frankfort for the past four years.

Beshear has been outspoken about Bevin’s attempts to reform Kentucky’s medicaid system. One of Beshear’s biggest frustrations, he told the Herald-Leader in April, was that he was forced to watch Bevin dismantle Kynect, the state health exchange his father’s administration built.

“It was an amazing feat of logistics, signing people up, having the largest decrease in our uninsured population three years in a row. It was an amazing feat from a technology standpoint because everyone else’s markets crashed online and ours thrived,” Beshear said. “...And (Bevin) tore it down, ultimately pushing more people onto the national exchange and I had to watch that even though our health exchange was so important and so good for Kentucky.”

In one of the first policy initiatives of his campaign, Beshear targeted Bevin’s medicaid waiver and said he’d repeal it if he were elected. In the same proposal, he promised to enshrine some of the more popular provisions of the Affordable Care Act — like guaranteed coverage for pre-existing conditions, “essential health benefits” and the ability for adults under 26 to stay on their parents’ health plans — into state law because of their uncertainty at the federal level.

That ideological battle has, like so many of the arguments between Bevin and Beshear, spilled into the courtroom.

Beshear has argued that Bevin’s decision to enter the case means the governor supports stripping healthcare protections from people with pre-existing conditions like diabetes or HIV.

“Matt Bevin just joined an effort to rip up health care protections for Kentuckians with pre-existing conditions,” Beshear said on Twitter “That’s dead wrong. Health care is on the line this election & I’m going to fight every day so our families can get the care they need.”

The Department of Labor has argued that the Association Health Plans are not exempt from covering pre-existing conditions (something Adam Meier the Secretary of the Cabinet for Health and Family Services has noted) but Beshear argued that because the associations aren’t forced to cover essential health benefits, it hurts people with pre-existing conditions who are reliant on prescriptions.

For their part, Bevin’s campaign has used the lawsuit to make another, perhaps more influential point in a race that could be determined on ideology — that Beshear doesn’t support President Trump.

“Andy Beshear is not being honest with the people of Kentucky, said Davis Paine, Bevin’s campaign manager. “He’d rather sue the Trump Administration and repeat tired, liberal talking points than have a serious conversation about how to make healthcare more affordable and sustainable for Kentucky’s small businesses.”

Daniel Desrochers has been the political reporter for the Lexington Herald-Leader since 2016. He previously worked for the Charleston Gazette-Mail in Charleston, West Virginia.