A Puzzling Paradox in Kentucky

Kentucky recently elected a Republican governor who made the rolling back of the Medicaid component of the Affordable Car Act (aka Obamacare) a central tenet of his campaign. Kentucky is (currently) the only southern state that signed onto this element of the ACA. Through it some 425,000 (yes, you read that right; close to a half of a million people) were enrolled in medical insurance plans that were paid for 100% by the government (yes, you read that right, the Feds pick up the entire cost of the Medicaid expansion).

What will happen if Governor elect Bevin goes through with this? Those 425k poor folks will lose their coverage. But, of course, they’ll still use health providers, clinics and other facilities. They will go to public hospitals when in trouble. The hospitals will have to treat them. They won’t be able to pay and the Commonwealth of Kentucky will have to pick up the bill. The overall health of residents will drop. The costs to the state will go up.

No one wins but the ideologues on the far right who have deluded themselves into thinking that Obamacare is, in Ben Carson’s immortal phrase, “the worst thing to happen to this country since slavery.”

Now, here’s the weird part. Right now the hospitals, clinics and private practices in Kentucky are seeing a flood of poor patients. They’re streaming into the ERs for procedures like having potentially cancerous growths removed, to MRI centers to have various symptoms that suggest that something internal may be amiss, to GP’s offices for checkups, to pediatricians to have their children’s ills taken care of.

Who are these folks? They are precisely the ones who are being targeted by Bevin’s plans. They know they are about to lose their coverage and be tossed back on the slag heap of the poor and destitute who didn’t have access to health care before the ACA and won’t have it again post Bevin.

But we’re just getting started in the insanity game: According to all the analyses of voting patterns in Kentucky (they’re reviewed in this piece in the NY Times) these poor folks, the ones who depend on Medicaid, just didn’t vote. In fact, practically no one voted in this election. The turnout was a miniscule 31% of the eligible meaning that some 17% of the voters in Kentucky brought about Bevin’s electoral victory.

We are left with a deep paradox. The poor couldn’t get their butts into the voting booth to stop this insane assault on their health care but they’re focused enough to make sure they get the last dribbles of decent health care which they are about to lose because they couldn’t bother to vote.