The McConnell campaign made clear he does not endorse the state exchange, but indicated it could survive a full blown repeal if the GOP takes over the Senate. "If Obamacare is repealed, Kentucky should decide for itself whether to keep KyNect or set up a different marketplace," McConnell campaign spokeswoman Allison Moore told WFPL. "But Kentuckians shouldn't have been forced to lose the plans they had and liked, shouldn't have seen their premiums skyrocket, shouldn't have had their Medicare cut, and shouldn't have had their taxes raised because of President Obama and his friends in Washington forced it down their throats."
Last week, Senate Minority Leader Mitch McConnell (R-Ky.) raised a few eyebrows with a deeply odd argument: he still intends to destroy the entirety of the Affordable Care Act, which he sees as "unrelated" to Kentucky's exchange marketplace, made possible through the Affordable Care Act.
Dave Weigel called McConnell's argument an "Obamacare word salad."
Yesterday, the Republican senator tried again.
Most of this is so wrong, it's only natural to wonder if even McConnell believes his own rhetoric. A small fraction of Kentuckians had to give up substandard plans through the individual market, but they transitioned to better coverage. Premiums haven't skyrocketed. Medicare wasn't cut. The vast majority of Kentuckians received a tax cut, not a tax increase. Shouldn't the senator know this?
Regardless, perhaps the most important part of this is McConnell's apparent belief that he can destroy the federal health care system, "root and branch," while leaving one of the largest branches in place. As Joe Sonka joked, "McConnell saying that Kynect can survive the repeal of Obamacare is like saying that the Oklahoma City Thunder can trade Kevin Durant, but keep his jump shot."
The facts are pretty straightforward. The federal law created and funded the exchange marketplace, where insurers compete for consumers' business.
But wait, McConnell and his allies argue, that was in the recent past. If Republicans can successfully demolish the American system in the near future, there's no reason Kentucky -- or any other state -- couldn't simply keep the exchange marketplace intact after the ACA is gone. Insurers can still compete, and consumers can still choose the plan that's best for them.
The problem, whether McConnell understands this or not, is that this is an incomplete view of how the system works. For most Kentuckians who visit the state-based exchange marketplace, there's a federal subsidy that makes insurance more affordable. For that matter, the coverage plans included in these exchanges are regulated heavily to guarantee consumer protections.
In other words, destroy the ACA and Kentucky would be left with something resembling its Kynect marketplace, only it'd offer worse and more expensive insurance plans. It'd be like keeping a car's chassis, but losing the engine.
Jon Gruber, the MIT professor who helped create Romneycare and Obamacare, told Sahil Kapur that state-run exchanges could exist post-repeal, but they'd be worthless.
"An exchange could exist without Obamacare -- but it would be largely irrelevant," Gruber said. "A number of states tried to set up group purchasing arrangements and related approaches pre-Obamacare and they by and large failed. Without tax credits and the mandate, there is little demand for the exchange -- and it does relatively little for the market."
Making matters even worse, many Kentuckians learn they're eligible for Medicaid coverage through the Kynect exchange. Destroy the law and Medicaid expansion disappears, leaving these families with nothing.
What I don't understand is why McConnell doesn't seem to recognize any of these details. He's not some rookie who's never held public office; he's a 30-year veteran of the Senate. McConnell has been in the chamber for the entirety of the debate over health care reform, and he's had several years to read up on the basic details of how the American system works.
So why is it, exactly, that the Senate Minority Leader seems so confused? And if the law is as awful and unpopular as McConnell claims, why does he have to reassure voters about leaving key provisions in place?
Update: The editorial board of the Lexington Herald Leader published a blistering editorial on this today, insisting McConnell "has some explaining to do."