Kentucky, one of the nation’s most deeply conservative states, has become the battleground in Republican efforts to repeal and replace the Affordable Care Act.
Last Saturday, Vice President Mike Pence came to Louisville to pitch the plan.
Next Monday, President Donald Trump will hold a rally in Louisville.
“It’s fascinating,” said Jonathan Miller, a Democrat who was elected two terms as Kentucky state treasurer. “We really are ground zero.”
But why Kentucky? Trump defeated Democrat Hillary Clinton in the Bluegrass State by nearly 30 points in November. The state has a fiercely conservative Republican governor, Matt Bevin, who campaigned on rolling back the Medicaid expansion initiated by his Democratic predecessor, Steve Beshear. Senate Majority Leader Mitch McConnell, R-Ky., is already a strong supporter, and chief Senate defender, of the Republicans’ American Health Care Act.
But not all Kentucky Republicans are on board with Trump and McConnell.
“The pattern would indicate that he’s using this as a way to pressure Rand Paul,” Miller said.
Sen. Paul, a Republican, has led the charge to defeat the Republican health care bill, which he calls “Obamacare lite.”
Last week, he appeared with a group of members of the conservative House Freedom Caucus who say the Republican bill too closely resembles Obamacare. Paul pushed for a “clean” repeal and a vote on more conservative health care bills, including his own.
If conservatives in the House of Representatives and the Senate remain firm, they could defeat the bill Trump supports or at least force big changes.
Even Bevin, who appeared with Pence on Saturday and was an early Trump supporter, has expressed doubts about the legislation. He told reporters last week that Paul wasn’t impressed with the bill, and nor was he.
“Truth be told, I’m not either,” Bevin said. “So I’m with him.”
While Democrats certainly oppose the GOP effort, they have more potential than in many conservative states to affect public opinion. Beshear expanded the state’s Medicaid rolls under Obamacare and delivered the party’s rebuttal to Trump’s recent speech to a joint session of Congress.
“You and your Republican allies in Congress seem determined to rip affordable health insurance away from millions of Americans who most need it,” Beshear said from a Lexington diner after Trump’s Feb. 28 speech. “This isn’t a game. It’s life and death.”
Beshear, who was governor from 2007 to 2015, expanded Medicaid under Obamacare. About 30 percent of Kentucky’s 4.4 million residents receive health care from the state-federal program, most of them low-income or disabled.
The state’s uninsured rate plunged from nearly 15 percent in 2013 to 6 percent in 2015 as more than 400,000 Kentuckians gained coverage.
Trump’s visit to Louisville will come just days after the Congressional Budget Office projected that 24 million Americans could lose coverage in the next 10 years under the proposal the White House is pushing.
Jerry Abramson, a former Louisville mayor and Kentucky lieutenant governor under Beshear, called Obamacare a “transformative” development for a state with lots of health problems and a historically high level of uninsured. People could finally get treatment for drug addiction and dental problems, he said.
“Those were all incredibly meaningful issues,” said Abramson, who was also President Barack Obama’s director of intergovernmental affairs. “That was the dream and it came to fruition.”
It could all change under the Republican health care bill, which would end the Medicaid expansion in 2020. Bevin is seeking additional changes to the state’s Medicaid program, including a requirement that recipients pay a premium. He has said the state can’t afford the program in its current form.
Louisville may seem like an unlikely place for Trump to make the health care pitch.
Jefferson County is one of only two Kentucky counties he didn’t carry. The local congressman, Rep. John Yarmuth, is the only Democrat in the state’s Washington delegation. Paul’s home base, where he practiced eye surgery prior to his election to the Senate in 2010, is nearly 100 miles south.
“If I were going to send him to Kentucky, I’d send him to Bowling Green,” Abramson said.
“I don’t understand the strategy here,” Miller added. “I’ve never understood Trump’s strategy.”