LIBERTY, Ky. — For the better part of a decade, Frank McAninch ignored many of his
ailments. A bad cold: “You weather it out yourself.” A torn rotator cuff from working
cattle: “Let time heal it.”
Then in early 2012, McAninch noticed a spot on his right cheek that became irritated
every time he shaved. A year after spotting it, he asked his primary care doctor to take
a look. McAninch said his doctor told him not to worry. But one year later, nothing had
changed.
At the time, visiting a dermatologist wasn’t an option for McAninch, who didn’t have
health insurance.
“If you get sick, you don’t go to the doctor unless it’s an emergency,” said McAninch, a
farmer living in Liberty, a small town in rural south central Kentucky. “And if you do, you
pay out of pocket.”
Fortunately for McAninch, he didn’t have to wait too long before seeing a dermatologist.
On Oct. 1, 2013, Kentucky’s health insurance exchange, Kynect, went live. The website
is the state’s implementation of the Affordable Care Act, which mandated health
insurance for individuals and gave states the option to set up their own insurance
exchanges in lieu of the federal government’s exchange, healthcare.gov. Seventeen
states, plus the District of Columbia, have chosen this option.
Within two weeks of Kynect’s launch, McAninch, a husband and father of two
daughters, applied for insurance and found out he qualified for Medicaid under the
health care law’s new eligibility requirements. For states such as Kentucky that have
chosen to expand Medicaid under the law, adults between the ages of 19 and 64 qualify
if their income is less than 138 percent of the federal poverty level (or $32,499 for a
family of four).
After receiving his coverage, McAninch visited a dermatologist who discovered that he
had squamous cell carcinoma, a non-melanoma skin cancer that can be dangerous if
not treated. The dermatologist removed it, leaving 47-year-old McAninch cancer free.
As of July, McAninch is one of some 521,000 Kentuckians who’ve received coverage
through the health insurance exchange, according to Carrie Banahan, executive director
of the Office of the Kentucky Health Benefit Exchange. The Kentucky exchange has
become a poster child for success because of the high number of people newly insured
through the system. A recent Gallup poll indicated that Kentucky’s uninsured rate has
dropped from 20.4 percent last year to 11.9 percent in mid-2014, the second steepest
decline after Arkansas.
To be sure, not everyone believes that Kynect will benefit the state in the long run, and
the issue has cropped up in the U.S. Senate race between Republican Senate Minority
Leader Mitch McConnell and Alison Lundergran Grimes, a Democrat. Critics have cited
looming Medicaid costs and spiked insurance rates as reasons why Kynect and the
ACA, also known as Obamacare, don’t work. Some point to evidence that Kynect’s
success may be premature.
For one, the majority of receiving coverage through Kynect – 300,000 – qualified for
Medicaid under new eligibility rules, rather than enrolling in private coverage. Critics
assert that this could put a strain on the state when the federal Medicaid subsidy drops
by 10 percent in 2020. It could also lead to increased fees on insurance providers,
resulting in higher health insurance prices.
“How to pay for the surge in Medicaid recipients, when we haven’t had a comparable
surge in paying insured is a problem that’s been put off so far,” said Stephen Voss,
associate professor of political science at the University of Kentucky. “The Republicans
here are predicting that there are going to be huge health care costs down the road
and when the actual costs of Kynect and the Medicaid enrollments hit, it’s going to be
extremely unpopular.”
But for McAninch and others living in rural Kentucky, health insurance means a
newfound security.
***
Sitting in a pink floral chair on a porch overlooking his group of bulls, McAninch recalled
the day, about four years ago, that a chainsaw gashed his shin. His wife, Renee, drove
him to an emergency room in town so that doctors could stitch up the wound. He paid
about $500 in out-of-pocket medical costs that day.
“You do what you have to,” McAninch said in an interview Tuesday, clad in a blue
and red flannel shirt tucked into light blue jeans, and a National Family Farm Coalition
baseball cap.
“But what if you had cut your limb off?” said Renee, leaning next to him on the porch.
“But I didn’t,” he said. “Thank goodness.”
It’s not the first time McAninch and Renee have played the “what if” game. They’ve
done it since Renee stopped working in the medical field 10 years ago to stay at home
with their daughters, and the couple lost their health insurance. McAninch’s job,
raising beef cattle, can be dangerous, and the fear of how he would pay for a serious
injury or illness always lingered.
When the dermatologist diagnosed McAninch with skin cancer, the family knew how
lucky they were to be covered. McAninch wonders how long he would have waited to
see a dermatologist, and what the health impact could have been. Since qualifying for
Medicaid, though, the family hasn’t had to worry.
“It gave me a sense of security to know that if anything was wrong, any health
issue, that we could go to the doctor, and it wouldn’t be – that the cost wouldn’t be
insurmountable,” he said. “That we could handle it.”
“A huge relief,” echoed Renee.
Just five miles away, one of McAninch’s friends, Michael Taylor, feels a sense of
peace too. Taylor is 43, a divorced father of two who manufactures and delivers farm
equipment. Before enrolling in health insurance through Kynect, he said he paid $700 a
month for individual health insurance, a premium that continued to spike after two back
surgeries and a stroke.
Taylor hadn’t paid much attention to Obamacare, but then McAninch, a friend, urged
him to look into Kynect. After enrolling, his monthly premium dropped to $120.
“It takes a lot of stress off. I bought a new truck with the money I saved from that,” he
said. “It means a lot. You get to see what you’re out here working every day for.”
***
Unlike the two Kentuckians, some Americans experienced long wait times, crashed
websites and frustration when they sought to enroll in the new health insurance
program. When McAninch and Taylor signed up, they made a quick call.
“It took about 20 minutes,” McAninch said. “I think I was on hold for maybe five, 10
minutes. No issue.”
The Kentucky exchange’s smooth enrollment process has stood in contrast to other
states that have had issues with their own rollouts. Massachusetts had to rely heavily
on paper enrollment applications because of its faulty website. In Oregon, technical
glitches rendered the state’s online exchange unusable, and it transitioned from a state-
based operation to the federal system, which has been riddled with its own problems.
But in Kentucky, more than 32,000 people enrolled in coverage within the first month
of Kynect’s operation. During the first enrollment period between Oct. 1, 2013 and April
15, 2014, three-quarters of enrollees indicated they were uninsured, according to Carrie
Banahan.
“We think one of the reasons that we’ve been successful is because of some of the
features and functionality available on the system,” Banahan said.
Banahan credits the simplicity of the exchange for its arguable success. Unlike other
state-based health insurance exchanges and the federal website, users didn’t have to
create an account in order to plug in their numbers to determine their eligibility status.
Banahan said it’s also one of the few states that offer a streamlined application process,
allowing shoppers to apply for Medicaid and qualified health plans in one shot.
To get the word out, the state advertised heavily, and trained 5,000 people to support
enrollment, including insurance agents and application counselors, called “Kynectors.”
And it helped that the state’s Democratic governor, Steve Beshear, has embraced the
Affordable Care Act and been a staunch advocate of the state-based exchange. The governor has seen Kynect as a way to boost the health of a state that ranks 45th among U.S. states in overall health and 45th in median household income.
***
The controversy over the health care law remains a divisive political issue that’s playing
out in Kentucky in the race between McConnell and Grimes.
McConnell shares the sentiment that the law has led to increased insurance prices and
higher deductibles, as well as a lack of access to doctors and hospitals. During a debate
with Grimes last week, he vowed to repeal it “root and branch” if reelected. During the
same debate, however, the senator mentioned that he would preserve Kynect, a notion
that Banahan asserted would be impossible if Obamacare were repealed.
Kynect “would not serve its purpose any longer,” she said.
Polls have showed that in Kentucky, the way health care is labeled makes a difference.
In an NBC and Marist survey released in May, a 56 percent majority of those polled said
they disliked Obamacare, while only 22 percent disliked Kynect. A national Gallup poll
earlier this month found that more people feel they have been hurt by the Affordable
Care Act than helped. Of those surveyed, 16 percent said they had been helped by
the law, 27 percent said they had been hurt by it and 54 percent felt it had no effect on
them.
“Obamacare on the one hand taps into the dislike that President Obama has here more
generally,” Voss said. “You stick his name in front of it, it reminds Kentucky voters of a
lot of things.”
For her part, Grimes has vowed that she will not take away coverage from the newly
insured, but has largely avoided praising the ACA and has said that she would work to
fix the law if elected.
According to Voss, however, the issue may not prove a deciding factor in Tuesday’s
election.
“I think on balance it’s really been a wash,” he said. “People who don’t like the national
Democrats, people who are turned off by references to President Obama, it’s just
another arrow in the quiver to use against the Democratic candidate. People who like
this [government] involvement, who are inclined to support it, it helps rile them up to
oppose McConnell.”
For McAninch, though, the notion that his health insurance could be ripped away
disturbs him. He believes that because he works year-round for 40 to 60 hours a week,
he deserves coverage. When Renee goes on vacation, he stays home. It’s up to him to
make sure that no cattle jump the fence.
“What do I do for a living? I feed this country. But there’s no one looking out for me,” he
said. “And I look back at what Obamacare did and it helped us.”