Senate Minority Leader Mitch McConnell wants Kentuckians to believe that Kynect (a health care portal they do like) and Obamacare (the less popular health care law that created Kynect) are not the same thing. After being criticized for that comment repeatedly, he made the same argument again during a debate on Monday with Democratic challenger Alison Lundergan Grimes.
“Kentucky Kynect is a website. It was paid for by a grant from the federal government,” he said. “The website can continue, but in my view the best interests of the country would be achieved by pulling out Obamacare root and branch.”
But if people like the website, they can keep it. “Yeah, I think it’s fine to have a website,” he said. Obamacare paid for that website, and pays for 100 percent (and, in future years, 90 percent) of the Medicaid expansion thousands of Kentucky residents benefitted from. In total, about 357,000 people signed up for Medicaid and 82,000 people signed up for private insurance in Kentucky. The vast majority of them wouldn't have been able to afford insurance without Obamacare, and wouldn't need a website.
The problem is, without the Affordable Care Act, Kynect's insurance plans wouldn't be subsidized, and its market wouldn't be as inclusive. “The exchange is dependent on a three legged stool,” Sabrina Corlette, a senior research fellow and project director at Georgetown University's Center on Health Insurance Reforms, said. Those legs are market reforms, such as no exclusions for people with pre-existing conditions, premium assistance to make health care plans more affordable, and an individual mandate that encourages healthy people to enroll in plans. “If you repeal the Affordable Care Act you're knocking down all three legs of that stool.”
Kynect could still exist, it would just be a shell of its former self. As Brian Beutler at The New Republic wrote, Kynect-Without-Obamacare already existed — it was called ehealthinsurance.com. “Take away Obamacare, and Kynect might still exist as a website,” Beutler wrote. “But it’d be about as useful to Kentuckians as ehealthinsurance was prior to last year.” The Lexington Herald-Leader reported last year that it will cost an estimated $39 million a year to keep Kynect running. According to a spokesperson for Kynect, funding for the site comes from a fee paid by all insurers offering insurance plans in state (both on and off the exchanges). That's a lot to pay for a site that's lost its main appeal.
And if Kentucky did want to recreate the Obamacare experience on a state level, it would likely take more effort (and state funds) than anyone in Kentucky would support. Larry Levitt, a senior vice president at the Kaiser Family Foundation, said that while a state might be able to recreate some of the success of Obamacare, it would require subsidies. The Massachusetts Health Connector, the most prominent example of a state-based exchange, also offered subsidized insurance. “To make an exchange like Kynect work, you really need the new insurance market rules,” Levitt said. And to make the rules work, you need the individual mandate. And to enforce the mandate, you need the subsidies. “It's really hard to do any one piece without the others,” he said.