As the Affordable Care Act has taken root, its implementation has moved in only one direction: forward. The health care law has seen more consumers, more Medicaid expansion, and more coverage. Aside from occasional, pointless repeal votes in Congress, there's been no meaningful effort to go backwards on "Obamacare."
Which is why Kentucky created such an interesting test. The Bluegrass State has been a national leader in ACA implementation, slashing its uninsured rate, and excelling in overhauling its health system. The results have been amazing for state residents. Republican Gov. Matt Bevin, however, vowed to make Kentucky the first state to reverse course, starting with the elimination of Medicaid expansion.
The assumption has long been that it's far more difficult to take Americans' health care benefits away than to block those benefits from existing in the first place. Would Bevin prove these assumptions wrong? Would he keep his campaign promise and scrap coverage for thousands of Kentucky families?
It now appears the answer to both of these questions is no. The Lexington Herald Leader reported late last week:
Gov. Matt Bevin says he intends to draft a plan to overhaul the state's expanded Medicaid program by the middle of next year, one that could be implemented by the start of 2017. [...] He said Wednesday that his plan will be fashioned after the one in Indiana, which uses waivers from the federal government that allow states to create their own system for providing coverage to the poor.
"Indiana's is the model that frankly is most likely that we will look to replicate," the governor added last week.
The trouble for Bevin's right-wing allies, of course, is that Indiana is already a Medicaid-expansion state. The new Kentucky governor, in other words, is planning to make the transition from Medicaid expansion to a slightly less generous version of Medicaid expansion.
This isn't at all what the Tea Party Republican promised as a candidate early last year, but there's apparently an important difference between vowing to take away health care benefits and actually following through on the threat.
It's worth emphasizing that many of the details of Bevin's approach have not yet been released. All we really know for now is that he wants Kentucky's system to effectively mirror Indiana's system, which would require federal approval.
But it's not too early to note the difference between pre-election Bevin and post-election Bevin. TPM's report put it this way: "By continuing Medicaid's expansion under Obamacare, Bevin will join a long line of GOP governors who have railed against the program but eventually come around to supporting it."
Many of Bevin's own supporters hoped he'd break his campaign promise. So far, that's working out pretty well for them.
Postscript: Charles Gaba noted that Bevin may be confused about the kind of waiver he's seeking from HHS. This should, I hope, become clearer when the governor adds details to his plan.