Kentucky Gov. Steve Beshear, a Democrat, was an early supporter of building a state exchange where residents without group coverage could buy health insurance. In July, he backed an expansion of Medicaid under the health law to provide coverage to more than 300,000 residents. Beshear, who is in his second term, has spent the past months promoting the law despite opposition from Republican leaders, including the state鈥檚 senior senator, Mitch McConnell. He spoke with KHN correspondent Phil Galewitz last week.聽His comments have been edited for space and clarity.
KHN:聽How will you counter all the negative and in some cases, inaccurate, statements being made about the Affordable Care Act as you launch the exchange in Kentucky?
BESHEAR:听We are ready to start enrollment on聽Oct 1. We have our call center up and running, and we鈥檙e starting to see an increase in calls as people realize that it is there. This is a work in progress. 鈥� A lot of people do not know anything about the Affordable Care Act (ACA),聽and too many people have heard all the misinformation. 鈥� For both of those reasons, we have a big task in front of us to educate people over the course of the next few months. We will meet the challenge. 鈥here are more than 640,000 uninsured Kentuckians,聽and with the expansion of Medicaid and with the exchange for the first time in history, we will be able to offer them something. This is a transformational change for our state.
KHN:聽How important is the work on the local level to ensure strong enrollment?
Gov. Beshear (Photo by Michael Loccisano/Getty Images)
BESHEAR:聽They touch people every day in our local health centers and health departments鈥e have several Kynecters [state聽navigators] out there,聽and 鈥� with the local efforts, [they] will be very important in this education process鈥� There is an excitement and willingness among people involved in health care聽that聽will make a huge difference.
KHN:聽Will the political opponents鈥� strong messages against the health law impact enrollment?
BESHEAR:聽 What politicians need to understand is most people are not hearing them聽 to start with, and not paying attention to political wrangling because they are too busy trying to support their families and live day to day. The misinformation is confusing to people,聽of course, and that is the intent 鈥� to confuse people and get them not to participate. But I think the opponents of the ACA are scared to death of being in a position a year from now, when people will look and wonder what all the noise was about, when they sit there with an insurance policy they can afford.
KHN:聽You waited nearly a year after the Supreme Court upheld the ACA to announce that Kentucky would expand Medicaid. Why the wait?
BESHEAR:聽I聽had a responsibility to answer the question of whether we could afford to do it and not place the state in a position of potential bankruptcy if all the numbers did not pan out. 鈥� I asked PriceWaterhouse Coopers to do an independent study of the economics of expanding Medicaid,聽and it took six months to find it would bring 176,000 jobs and have a positive impact of over $800 million over the next eight years.
KHN:聽Kentucky was one of first states to embrace the exchange idea but a lot of work is still being done at the last minute to make sure you are ready to go. What鈥檚 the status?
BESHEAR:聽Kentucky is way ahead of most other states in terms of implementation of the exchange. 鈥� This is a transformational聽moment in this state and this country,聽and it鈥檚 going to be a work in progress with bumps in the road to be sure.聽But I am excited about this and sooner or later, every one of the 640,000 people will be covered through the exchange. 鈥� There is no artificial [enrollment] goal for January,聽but we are going to push hard to get as many people enrolled by聽March 31聽as we can.
KHN:听What are your major concerns about the聽Oct 1聽launch of the exchange?
BESHEAR:聽I have no big concerns. People have worked hard to be ready,and we have been planning this for months and have had wonderful cooperation between the public and private sectors,聽and we will hit the ground running on聽Oct 1.
KHN:聽What does this moment mean for your state?
BESHEAR:聽This will change the course of history in Kentucky. We are one of the least healthy states in the country 鈥� 44th聽in overall health status聽鈥揳nd for many chronic conditions,聽we are right at the top. For every one of our Kentuckians to now have good health care coverage will transform our society. We won鈥檛 see the difference in the next week or the next year,聽but over the next generation, we will see a change in the health of our people and the productivity of our workforce will be a huge positive.
KHN:聽To be sure,聽Governor,聽health insurance is not the only factor that influences health. Doesn鈥檛 personal behavior, such as diet and exercise, play a big role too?
BESHEAR:聽People will have access. and part of what they will begin learning is to take responsibility for themselves. 鈥� A big emphasis in the policies [sold on the exchange] is preventive medicine and educating people about vaccines and knowing how to manage their diabetes and other illnesses. 鈥� A major part of this is people learning how to take better care of themselves and stay out of the emergency room and have their care managed by a primary care professional. That in the long run will make a major impact on health care.