GOP healthcare confusion

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If Kentuckians like their healthcare exchange, can they keep it — even if ObamaCare is repealed?

Sen. Mitch McConnell’s (R-Ky.) campaign has been arguing just that this week, after the Senate minority leader said Friday that his push for the healthcare law’s repeal was “unconnected” to the existence of Kynect, the state’s exchange.

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Healthcare experts have widely panned McConnell’s claims, with one calling him “delusional.”

But McConnell’s tap dance highlights the difficulty facing Republicans as they grapple with their message of repeal in the face of benefits the law is now delivering.

Democrats have been slow to jump on the comments, a reflection of their reluctance to make ObamaCare an issue, particularly in red-leaning states like Kentucky, where Obama remains deeply unpopular. 

And if they can’t find a way in Kentucky, which boasts one of the nation’s most successful state-based exchanges, it's hard to see how they’ll manage to do it elsewhere, as a veteran state political reporter and University of Kentucky professor Al Cross points out.

“If there’s a strongly anti-Obama state in which there is a good argument for ObamaCare, this is it,” he said. “There is an argument to be made for the law, and the fact that the Democrats haven’t quite figured out whether to do it, or how to do it, illustrates the depth of the problem.”

But the campaign of McConnell’s Democratic opponent, Kentucky Secretary of State Alison Lundergan Grimes, waited five days before weighing in — and not before ample prodding from reporters.

Grimes’s campaign adviser Jonathan Hurst said in a statement Wednesday that McConnell “has been in the fantasyland that is Washington for so long that he cannot tell the difference between fact and fiction.” 

Kentucky Democratic Gov. Steve Beshear said on Wednesday, in a statement from the state Democratic Party, the senator “either doesn't understand what the ACA [Affordable Care Act] is, or is just trying to mislead Kentucky families for his political benefit at their expense."

But Grimes’s delay drew criticism from some Democrats and, for a time, allowed Republicans to hone in on her refusal to say whether she’d vote for the law.

And that’s despite the fact the McConnell campaign has stood by his original comments. Campaign spokeswoman Allison Moore said earlier this week that Kentuckians should be able to decide whether to keep the exchange if the law were repealed, and McConnell adviser Josh Holmes doubled down on Wednesday, telling The Hill that it was, in fact, the law’s supporters who didn’t understand the rationale. 

"What most of this boils down to is proof positive that many of the most vocal proponents of ObamaCare, like the lawmakers who passed it, have absolutely no idea how it works,” Holmes said in an email. “We've got people getting kicked out of plans they enjoyed and thrown into Medicaid or some more expensive plan, and the White House is calling their enrollment statistic a success. In what universe is that a success?"

But Tim Jost, a leading authority on the Affordable Care Act, called McConnell’s comments, and the subsequent elaboration from his campaign, "ridiculous."

"If you repeal the Affordable Care Act and eliminate the tax credits, eliminate the Medicaid expansion and eliminate the market reforms, there is nothing left," said Jost, a professor at Washington and Lee University School of Law, who is a backer of ObamaCare.

While Kentucky might be able to operate a website for buying health coverage, experts said, it is unlikely the system would serve all patients regardless of their health or offer generous discounts on coverage.

In short, Kynect would cease to exist under repeal, they said.

"An exchange is not a physical structure that has been built and is still standing," said Sabrina Corlette, a senior research fellow with the Georgetown University Center on Health Insurance Reforms.

"It's a marketplace that depends on a common set of rules for health plans and the tax credits to make those plans more affordable. If you take those away with repeal, there is nothing left."

McConnell "needs to go back and read the law," she added, calling his claims "delusional."

The senator’s campaign, however, says they were thrilled with the news cycle he sparked Friday.

“We couldn’t be happier to be talking about ObamaCare right now. National Dems are making it impossible for Grimes by pushing this story. We see absolutely no political downside here,” a top McConnell adviser told The Hill.

That’s because in Kentucky, like other red-leaning states, the issue really is semantics: The law known as “ObamaCare” polls worse than specific provisions or exchanges.

“It’s not that ObamaCare is all that unpopular; it’s that Obama is — and he’s three syllables of the four,” Cross said. “And the number of syllables is probably indicative of the weight that his unpopularity gives to the subject matter.”

That’s why Democrats in the state have been touting the success of “BeshearCare” instead — any mention of the O-word immediately turns a potential asset into a liability.

Democrats can argue that McConnell is at best dissimulating and at worst lying — and they have — but that requires them to draw the connection between the popular Kentucky Kynect and the unpopular ObamaCare. There, they risk wading into a debate on the Obama White House’s overreach and initial mismanagement of the law or also tainting Kynect’s popularity. 

Multiple Kentucky Democrats pointed to Rep. Andy Barr’s (R-Ky.) opponent, Elisabeth Jensen, as a potential model for Grimes’s campaign on the healthcare law.

Jensen, an education nonprofit director, has run attacking Barr for wanting to repeal the law, and said in an interview that the healthcare law has been a success in Kentucky, and “every Democrat should run on it.”

She even noted that the success of the healthcare law’s implementation in Kentucky would make it difficult for Republicans in the state to make their case against ObamaCare.

“It’s going to be hard for them to campaign against it. They’re going to have to show they’re fighting against something different” from Kynect, Jensen said. 

But Jensen’s walking her own tightrope on the law, drawing the same contrast between Kynect and ObamaCare that McConnell did on Friday. Jensen’s comments signaled that, for Democrats, ObamaCare by any other name smells much sweeter.

“ObamaCare’s Andy’s thing. He can worry about fixing ObamaCare in Washington. I’m here in Kentucky supporting Kentucky Kynect,” she said.