Enduring riddles from the 2015 election

The enduring riddle of the 2015 election is why the candidate who promised to cut Medicaid carried the places that most depend on Medicaid, the government program that provides 1.3 million low-income and disabled Kentuckians with access to health care.

Take the 36-year-old woman in Owsley County interviewed by the Herald-Leader’s John Cheves. Gov.-elect Matt Bevin’s promises could make her hyperthyroidism treatment unaffordable. She voted for him because she’s “a die-hard Republican,” prompting commenters to mull the meaning of “dying hard.”

In Pikeville, The Washington Post interviewed a 56-year-old unemployed mechanic and former coal miner who gained access to medical treatment for a host of ailments when he signed up for Medicaid through Kynect, the health insurance exchange that Bevin vowed to close. He said he voted for Bevin but “could probably die” if he loses his recently-acquired Medicaid card.

Transylvania University political scientist Andrea Malji ran the numbers, as Cheves reported on Sunday, and found a near-perfect correlation between counties’ Medicaid enrollments and their gubernatorial choices. The larger the Medicaid enrollment, the more likely they were to vote for Bevin. The lower the Medicaid numbers, the more likely they were to be carried by Democrat Jack Conway.

The places that gained the most from Democratic Gov. Steve Beshear’s decisions to expand access to health care supported the Republican who promised to end or roll back access.

Beshear made the most of the opportunities created by the federal health care law signed by President Barack Obama. As a result, 500,000 Kentuckians gained medical care, many for the first time, through subsidized private insurance or Medicaid that was expanded to cover people up to 138 percent of poverty ($16,105 a year for an individual.) Kentucky's uninsured rate dropped from 20 percent in 2013 to 9 percent this year, according to the Gallup-Healthways Well-Being Index. It was Beshear’s central achievement, one that he said would make a huge difference in a generation.

The biggest drops in the percent of uninsured were in Southeastern Kentucky, where Bevin carried even traditionally Democratic counties.

Asked by reporters on Tuesday why voters appeared to reject the health care reforms by giving Bevin a 9 point victory, the outgoing governor cited low turnout (31 percent of voters), Bevin’s advantage as an “outsider,” social concerns such as gay marriage and voters not “paying attention” to the issues.

Yet, Democrats never campaigned on what was hailed far and wide as Kentucky’s health-care success story. Conway made little effort to educate the public about the heavy costs of Kentucky’s high rates of disease and disability or the brighter future that awaits healthier workers and their state. Did you see a single ad in which Conway stood beside someone like the unemployed mechanic in Pikeville and said I will fight for your right to health care? Neither did we.

If anything, Conway and his fellow Democrats ran from their health-care successes because of the association with Obama. No doubt their consultants told them that Kentuckians could not separate their antipathy for the president from their self-interest in having medical care or neighbors who are healthy enough to work and support themselves. And maybe that’s right. But it would be good to know that Bevin voters understood all that was at stake.

Democrats can’t expect voters to pay attention to the issues when their own candidates shy away from showcasing the most crucial difference in an election.

Another enduring riddle of the 2015 election: Can Democrats articulate a compelling vision in which Kentuckians can believe.