Will Obamacare heal an ailing state?

FRANKFORT, Ky. — Relations between President Barack Obama and Kentucky Gov. Steve Beshear have not always been friendly. When Obama paid his first presidential visit in May 2011, his fellow Democrat was somewhere else. Later, Beshear lashed out at the administration’s environmental regulators, telling them to “get off our backs.”

But leading one of the nation’s poorest, sickest states, Beshear has improbably overseen one of the most successful rollouts of Obama’s troubled health care overhaul and become, deep in his long public career, a hero to Democrats grasping to find a redeeming figure amid the political wreckage.

He’s an unlikely champion, not least because Kentucky’s two U.S. senators are both implacable opponents of the program.

“I knew if I was going to make a huge difference in the health status of Kentucky, it was going to take some kind of transformational tool to do that, and that’s what the Affordable Care Act is for me,” Beshear, white-haired and greyhound-lean, said as he sat behind a big maple desk in the governor’s office. “I think we’ve started something here,” he later added, “that a generation from now you’ll see a very different Kentucky than what you see today.”

For now, Kentuckians may feel understandably whiplashed.

While Beshear, serving his second and final term, has become one of the foremost proponents of Obamacare, the state’s senior senator, Republican leader Mitch McConnell, has been an even more visible foe. Facing a tough 2014 re-election fight, he calls the law “a disaster,” “a huge mistake” and “a monstrosity” that “needs to be pulled out root and branch.” The sentiment is seconded by Kentucky’s junior senator, Republican Rand Paul, who was elected in 2010 in a tea party fever born of seething opposition to the president and his health care plan.

Both sides marshal selective facts to argue their cases. About 640,000 Kentuckians, or about 1 in 6, lack health care insurance. As of this week, more than 60,000 of them had signed up for coverage through the state’s insurance marketplace, which has operated smoothly from the start.

At the same time, about 280,000 Kentucky residents could lose their existing health insurance under standards set by the new federal law, which would force them to scramble in the next few weeks to find replacement coverage in the state exchange or elsewhere.

The need for care in this pretty but hard-pressed state is unarguable. Kentucky leads the nation in cancer deaths and preventable hospitalizations and suffers some of the highest rates of diabetes, cardiovascular illness and premature death. Extending health care to as many as possible could make a difference, the 69-year-old Beshear said, long after he is gone. “To me,” he said, “it was the morally responsible and the right thing to do.”

Born in rural western Kentucky, the son of a Baptist minister, Beshear first won office at age 29. After three terms in the Legislature, he was elected state attorney general at 35. But unlike a young, ambitious Democrat from Arkansas whose early success propelled him to the White House, Beshear’s political career stalled after a series of setbacks, including an unsuccessful 1996 Senate run against McConnell.

After several years practicing law, Beshear staged a political comeback in 2007 when he beat a scandal-stained Republican to become governor. He arrived just in time for the Great Recession, which, along with an intransigent GOP-led state Senate, thwarted most of his larger ambitions. A signature plan to expand legal gambling to boost education funding has been thwarted. An attempt at overhauling the state tax system appears similarly stymied.

Obama’s health care law presented a chance to do something big, and lasting.

Empowered to act without the Legislature’s approval, Beshear became the only Southern governor to embrace a provision vastly expanding Medicaid eligibility and open a state-run exchange for others seeking insurance. He conceded, with a small smile, that it was easier knowing he would never face voters again. “But,” he went on, “I’m convinced that in the end this is not going to (be) a negative political issue.”

He acted, Beshear said, only after independent analysts predicted the health care overhaul would inject more than $15 billion into Kentucky’s economy over the next eight years, create about 17,000 new jobs and produce about $800 million in state revenues. “You cannot afford not to do this,” he said he was told.

Paul, for one, is skeptical. At a sort of impromptu debate at the Kentucky Farm Bureau’s annual breakfast last summer, the senator followed Beshear to the microphone and challenged his optimistic forecast. “It’s going to bring $15 billion to our state. From where?” Paul demanded, his voice rising. “From the Federal Reserve, which is already sitting at minus $17 trillion. It’s not free. There are consequences to this.”

Embracing the health care overhaul, known as Obamacare, is not without political risk. Undaunted by the early success in Kentucky, Republicans plan to make the controversial program a major issue in 2014, when the GOP will be vying to take control of the state House for the first time in close to a century.

Beshear, who steps down in a little over two years, insisted he was not concerned about his legacy. But there is something he hopes to leave behind in Frankfort: his son, Andy, is running for attorney general in 2015.

“Obviously, his mom and I are excited about that and we’re going to fully support him,” Beshear said, grinning. The health care issue, the governor suggested, won’t make a difference in the race for the state’s law enforcement chief one way or the other.

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