Kentucky Gov. Steve Beshear (D) announced on Thursday that he would accept federal money to expand his state’s Medicaid program under Obamacare. That brings the total number of states participating in the optional expansion up to either 22 or 18 (plus the District of Columbia) — depending on the actions of some state legislatures that are still debating the issue.
According to a press release from Beshear’s office, the governor called the move “the single-most important decision in our lifetime for improving the health of Kentuckians” and something that is “in the best interest of the Commonwealth and its citizens.” He also stated that an analysis of the expansion’s costs revealed that non-participation would be mean losing money for the state, echoing the fiscal argument made by West Virginia Gov. Earl Ray Tomblin (D) last week.
Beshear certainly has his numbers right. According to the Kaiser Family Foundation, Medicaid expansion will cut Kentucky’s high uninsurance rate by over 55 percent, and the price of noncompliance could be as high as $40 million by 2021. Considering upcoming cuts to safety net hospitals that serve poor residents and the reality that nearly one in three Kentuckians living below 139 percent of the Federal Poverty Level (FPL) is uninsured, that would have proven to be an unaffordable cost from both a fiscal and a public health standpoint.
What’s less clear is how much difficulty Beshear will have with gaining the support of lawmakers in a state that has elected ardent Obamacare opponents like Sens. Mitch McConnell (R) and Rand Paul (R). Democrats hold an 11-seat edge in Kentucky’s state House, while Republicans hold an 11-seat edge in the state Senate. Convincing those 11 Republican state senators could be difficult, considering that several other GOP governors in highly uninsured states are still battling their own party members to cooperate with the health law’s Medicaid expansion.