How Kentucky Got Obamacare Right

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by Steven Brill,

from TIME Magazine,

In the deep-red, Bluegrass state, the Affordable Care Act is an unlikely hit. Just don’t call it by that name.

About a year ago, on Aug. 22, a team of inspectors from the Centers for Medicare and Medicaid Services (CMS) unit of the U.S. Department of Health and Human Services arrived in Frankfort, Ky., to see if the people working out of a nondescript warehouse there were going to be able to pull off the launch of Kentucky’s Obamacare health-insurance exchange.

There was less than six weeks to go before the scheduled Oct. 1 debut, in Kentucky and nationally, of what was perhaps the most complicated e-commerce venture ever envisioned.

They need not have worried. Over the past year, Kentucky’s health care website has proved to be a huge success. More than a half-million Kentucky residents have signed up for the Bluegrass State’s version of Obamacare. A majority of Kentuckians approve of it. That this has happened in a deeply red state is unexpected but hardly an accident.

This is the story of how one state, led by Governor Steven Beshear and a team of smart, determined career civil servants, got it right–by preparing exhaustively, by dealing frontally with the system’s challenges and by celebrating rather than soft-pedaling the reality that Obamacare is a social-welfare program intended to help the poor and the middle class get health care coverage. It’s also a story about how the politics of Obamacare has played out differently in Kentucky compared with much of the rest of the country. Which helps explain why the Affordable Care Act, as put into place elsewhere, may never become as broadly popular as Social Security or Medicare–even if it survives as long as those programs.

What happened in the Frankfort warehouse a year ago should have happened in every state–and in Washington. For three days, “the federal people put us through the paces,” recalls Beshear, a Democrat who had embraced Obamacare as an especially important initiative in a state with some of the nation’s worst health care statistics.

But beyond the numbers, there is a political difference. Obamacare continues to be a loser or at best a toss-up politically across much of the country. In Kentucky–one of the reddest of red states, where Obama lost to Mitt Romney 60% to 38% in 2012 and would surely lose by more today–Obamacare is a winner.

Only it’s not known as Obamacare. It’s called Kynect, the name Beshear smartly gave it in the run-up to the launch.

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