Matt Bevin’s hard choice, killing hundreds of Kentuckians or his political future

Kentucky Republican senatorial candidate Matt Bevin arrives at Lexington Airport for a campaign stop in Lexington, Kentucky, May 19, 2014. Bevin has a full day of campaigning scheduled in advance of tomorrow's Republican primary against Senate Minority Le

Republicans see Matt Bevins’ win in Kentucky as an anti-Obamacare mandate, despite the fact that polls have shown that Kentuckians like their own version of it—Kynect—that Bevins promised to undo if elected, and therefore might not have been voting on that issue. That, and the prospect of more than 400,000 people being kicked out of their healthcare, played into why Bevins backpedaled on his initial promises of total repeal as the campaign wore on. But he’s not going to be let off the hook so easily by fellow Republicans.

“(Bevin) is the one who has received the mandate here. We have to do something different,” said Republican state Sen. Ralph Alvarado, a doctor who opposes the Affordable Care Act. “The legislature and the governor need to follow through. It’s clear on what voters are telling us they want to do.”

Some Republicans are insisting on claiming that mandate,

it’s there or not. That’s going to put significant pressure on Bevins to try to do his worst, and that means putting a lot of people in jeopardy in a state that has undeniably one of the greatest Obamacare success stories.

Torching Kynect (which incidentally means flushing something like $200 million in government money down the toilet) would theoretically still let people find insurance on the federal exchange, but should he rescind the Medicaid expansion, roughly 400,000 people will lose coverage immediately.
How many would die? I have previously calculated the excess death rate due to lack of coverage at 0.0005 to 0.0009 per year. That means between 200 and 360 deaths, every year. It’s not hard to believe, either—under ObamaCare, common preventative care is up in Kentucky between 88 and 187 percent.

Last year, Medicaid expansion paid out $506 million to the state’s hospitals, which would be a massive loss were Bevin to figure out how to undo the expansion entirely. You can bet that Bevin is going to be feeling some pressure from that sector, starting right about yesterday. Here’s something else Bevin should be keeping in mind: the best polling done so far, by the Kaiser Family Foundation, shows that Republicans actually approve of Medicaid expansion. It’s a slim majority, but a majority nonetheless.

There’s a great deal for Kentucky, and therefore Bevin, to lose if he listens to the extremes in his state and guts Kynect. His softened stance as the campaign wore on suggests that he might be more of a cagey politician than an ideologue, if his base lets him.

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