Why One Red-State Governor Loves Obamacare

Kentucky's Steve Beshear, a Democrat, has embraced the Affordable Care Act — and thinks it will outlast his successors, whichever party they come from.

Kentucky Gov. Steve Beshear.  (National Journal)

Steve Beshear, Kentucky's Democratic governor, is the great exception. Almost all the governors embracing President Obama's health care law lead states that lean solidly Democratic in presidential elections. Beshear is passionately pushing Obamacare in a state that gave Mitt Romney 61 percent of its vote in 2012. Now finishing his second and final term as governor, Beshear explained his strategy in a conversation last week at National Journal's Countdown to Transformation health care event in Washington. Edited excerpts follow.

You may be the test case on whether active, aggressive implementation of the Affordable Care Act will be accepted in a red state. What do you see?

We've got the naysayers out here saying, "This is gonna be a train wreck." Well, they're on the wrong train, because this thing so far is a huge success. In Kentucky, we've been hearing this stuff over and over again now for a year, and most folks haven't heard a lot of positive input about it. But, man, at 12:01 midnight Oct. 1, that [exchange] lit up and it's been lit up ever since, and you've got hundreds of thousands of people that are anxious to find out about this.

Do you think there will be cultural or ideological resistance to signing on?

I'm sure there will be some, just like there'll be some people in every state that, just from an ideological standpoint, won't do it. I had a caller this morning on the C-SPAN program I was on, and he just raved and ranted about the whole thing. I said, "All I do is challenge you to go look; it's not going to cost you anything. You don't even have to like the president, and then if you find something that's really good for your family, shame on you if you don't get it for your family."

The way you were able to implement this was unique. Talk a little about it.

Well, fortunately years ago, the Legislature delegated to our Cabinet the responsibility for Medicaid benefits and eligibility, and so all we had to do was issue an administrative regulation and expand those benefits. Then I issued an executive order setting up the exchange. I was sued by some who said that I didn't have the authority, and I won.

In 2015, Kentucky will elect a new governor. If there is a Republican governor and a Republican Legislature, do you think this will be vulnerable to reversal?

I think, by then, the roots will be too deep. Let's face it, when you look at Kentucky and you look at the many areas where most of the uninsured live — yes, some are in our urban areas, but many of them live in our rural areas that are represented by Republican legislators. So once they have this coverage, I really don't think politicians are going to try to take it away.

How long does the admini­stration have to get the exchanges together before it starts creating larger questions about the program?

I don't think there's any artificial deadlines. It's going to get better every day, and people are going to get on there. I tell you, there's a pent-up demand for this. I'll make a prediction: In another year or two, people are going to look back and say, "What was all this yelling and screaming about?"

What will change if you can significantly reduce the number of uninsured?

Over the course of a generation, this will make a huge difference in Kentucky. It will make a huge difference in our workforce. When you have a healthy workforce, then you don't have the absenteeism. It's going to give us a huge advantage in terms of attracting business and new jobs to our state. I want everybody in our state to have the comfort and the confidence that they won't go bankrupt tomorrow if they get sick, that they can take their kids to the doctor and get their shots, that they can take their kids to the dentist and get their teeth filled. For Kentucky, that's going to be a major sea change.

Roughly half the states are embracing this law, and the other half are resisting. Can we sustain this house divided on health care?

In the long haul, every state is going to do this because their people are going to demand it, particularly after they look at places like Kentucky that do it, and they see — wow, it worked. I've never seen the dysfunctionality in government that we see right now, particularly up here in Washington. These folks act like a bunch of 9-year-olds in a food fight in a cafeteria. And we're paying them to do this. That's the amazing thing. It's time they act like adults.

Do you worry this law will be a liability in the 2014 Senate race in Kentucky?

If things continue to go as they're going right now, and people kind of open up to this like they're doing, and listen and educate themselves, I think it's going to start to boomerang on these folks that are out there yelling and screaming right now.