The following remarks were delivered by Former Governor of Kentucky, Steven Beshear, at AcademyHealth's National Health Policy Conference on Monday, February 1 during the opening plenary session.
I was proud to host your visit to the Governor’s Mansion in Kentucky early in my administration, and I’m thrilled that you and the Academy have returned the favor by inviting me here to talk about the critical issue of health care.
There is no more pressing issue for our country today.
Good health is the foundation of everything from a competitive workforce to the financial security of our families, and that’s why I have a message for elected leaders and candidates both here in Washington and in our state capitols.
That message is this:
This is not about you.
It’s not about your political ideology, or your partisan gamesmanship, or your personal aspirations.
In fact, take the politics out of it altogether.
What this issue is about … is people.
The good health of our people, and the collective health of our communities.
That – and only that – should be the basis for your decisions.
And if you can’t explain how your policy and rhetoric on health care will lead to better health outcomes … then quite simply you need to change your policies and rhetoric.
The American people are tired – in fact, they’re more than tired, they’re angry – about leaders who put ideology ahead of people.
Look, I was governor of Kentucky for eight years.
And in that time we made incredible progress toward improving the health of a very unhealthy state.
We did it because we had strategic vision … we were bold in implementing it … we relied on facts and research to set policy … and we brought to the table a wide variety of stakeholders and partners in both the public and private sectors, including our providers and our universities.
Some of those partners are here today.
But that progress is now in jeopardy.
To help himself get elected, my successor in the governor’s office spent a lot of time on the campaign trail parroting the standard anti-Obama rhetoric that plays well to the anti-establishment crowd.
He promised to kick people off Medicaid.
He promised to destroy the nation’s most successful state-based health benefit exchange and send Kentuckians to the federal exchange.
And he promised to make the poor pay more for their care.
Now that he’s in office, he says he has to fulfill his campaign promises.
Not because it’s going to improve the health of Kentuckians … and certainly not because it makes financial sense … but because it conforms to his partisan ideology and because he dislikes our president.
That’s precisely the short-term self-absorbed thinking that I’m warning against.
In our few short conversations before I left office, and in my public statements on the way out the door, I urged him to consider the facts and the research before making up his mind on health-care reform.
As I’m fond of saying, everyone is entitled to their own opinions, but no one is entitled to their own facts.
And the facts tell the truth.
I’m a big fan of facts and research, and so I’ve relied on that kind of evidence every step of Kentucky’s path toward better health.
And in Kentucky, the facts make a clear case for continuing what we started.
So those of you who do the research and measure the outcomes – you’re more important than ever before.
And I mean that not only on the federal level but also, and especially, on the state level where much of this is playing out.
You’ll better understand the urgency of my message if I start at the beginning and tell you Kentucky’s story:
Kentucky is a gorgeous state.
Beautiful landscapes, rich history, interesting arts community, friendly people.
We look out for each other.
But for generations Kentucky has been held back by fundamental weaknesses, including the stubborn problem of poor health.
Kentucky’s collective health has long been terrible.
In almost every measure there is, we have long ranked near the bottom or at the bottom.
The suffering is deep.
Kentuckians are sicker than most.
We die too early.
And our families go bankrupt paying to treat diseases and chronic conditions.
For our state as a whole, our poor health has had terrible consequences.
There is a direct line between this problem and almost every challenge Kentucky faces – whether that’s poverty, unemployment, lags in education attainment, substance abuse or crime.
Big problems require big solutions.
During the eight years I was Governor, we employed a series of those:
- An aggressive push toward electronic medical records.
- A new delivery model for Medicaid.
- Expansion of Medicaid eligibility standards.
- Creation of a state-run Health Benefit Exchange called “kynect.”
- Wider access to substance abuse and behavioral health treatment.
- A wide-ranging attack on our addiction to prescription pain-killers.
- Regulation of e-cigarettes.
- And a multi-pronged initiative called “kyhealthnow” that zeroed in on long-standing health problems like obesity, smoking, dental decay and heart disease.
Heck, I even used an executive order to forbid smoking on the grounds of state buildings.
Collectively, these health-related initiatives represented a fundamental overhaul of core elements like how people access care … how that health care is delivered … who can access that care … and what services they receive.
Truly it was reform with a capital “R.”
And with it we began to change the course of Kentucky’s history.
One of the biggest reasons for our poor health has been lack of access to health coverage.
When we started, an estimated 640,000 people in Kentucky were uninsured.
That was almost one in six Kentuckians.
Lack of health coverage was jeopardizing their health and financial security. They rolled the dice and prayed that they didn’t get sick. They chose between food and medicine. They ignored checkups that would catch serious conditions early. They put off doctor’s appointments, hoping a lump or a pain turned out to be nothing. And they lived knowing that bankruptcy was just one bad diagnosis away.
Furthermore, their children were going long periods without checkups that focused on immunizations, preventive care and vision and hearing tests.
Now, these aren’t strangers -- they’re our friends and neighbors.
We sit in the pews with them on Sunday and in the high school bleachers with them on Friday night. Many of them have jobs, but their employer either doesn’t offer insurance or it’s priced out of reach. So they and their families were left out in the cold.
We set out to change that, by expanding Medicaid eligibility to 138 percent of the federal poverty level and by becoming one of the first states to create its own exchange.
The exchange – Kynect – worked from the start.
In fact, President Obama called me and jokingly asked if he could borrow my computer techs.
We were the only southern state to embrace expansion and its own exchange.
Now, it might seem that Kentucky was an odd choice to become Obamacare’s flag-bearer.
After all, Rand Paul and Mitch McConnell are our Senators, five of our six Congressmen are conservative Republicans … and the President himself is about as popular in Kentucky as the Duke Blue Devils.
But there’s a huge disconnect between the rank partisanship of national politics and governors whose job it is to help beleaguered families, strengthen work forces, attract companies and build a balanced budget.
And I knew our people needed help. But before I moved forward, I wanted to make sure we could afford it. So I sought expert outside analysis.
I hired both Pricewaterhouse Coopers and the University of Louisville’s Urban Studies Institute to do a study.
They concluded that expanding Medicaid would:
- Inject $15.6 billion into Kentucky’s economy over the next eight years.
- Create almost 17,000 new jobs.
- Turn costly new federal mandates into an $800 million positive budget impact.
- Protect hospitals from cuts in indigent care funding.
- And shield businesses from up to $48 million in annual penalties.
So I ignored the political risk and forged ahead, using the Governor’s power of executive order.
I figured that anything worth doing is worth doing right. And worth defending.
In response to criticism, I told Sens. McConnell and Paul that Kentucky would benefit if they worked just as hard to help Kentuckians get healthy as they did in trying to undermine the Affordable Care Act.
I wrote an op-ed in The New York Times where I told critics:
“Get over it … and get out of the way so I can help my people. Here in Kentucky, we cannot afford to waste another day or another life.”
Well … that got attention.
Suddenly, I was the face and voice of health care for the vulnerable, appearing in print media like The Wall Street Journal and The Economist; in broadcast media and programs like the BBC, CNN, MSNBC and “Hardball”; and on Web-based sites like Slate, The Daily Beast and National Journal.
I was put in a book and I even got an invite and a shout-out in the President’s State of the Union address.
That was a little exciting and very humbling.
But what really gave me satisfaction was the response from ordinary Kentuckians who suddenly found good health and hope within their reach.
I couldn’t open the mail or go out in public without someone telling me a tearful story about their health.
We had created a way for over half a million Kentuckians to access health coverage, many of them for the first time, and they began accessing preventive care, screenings and health checkups at unprecedented levels.
At least three separate studies listed Kentucky as either one of the leaders or the leader cutting our uninsured rate.
One study said our uninsured rate went from over 20 percent to 9 percent.
Look, there are only two factors on which to judge the health-care solutions we’ve employed in the last eight years:
One, are they working? And two, can we afford them?
Research and facts show the answer to both questions is “yes.”
“Yes,” they’re working … “yes” Kentucky can afford them.
A year into expanded Medicaid, we hired Deloitte Consulting and the U of L Urban Studies Institute to study performance data, to see if the earlier projections held up.
Turns out, the projections weren’t rosy enough.
In the first year alone, more than 12,000 jobs were created in Kentucky.
Health-care providers in the state received at least $1.3 billion in new Medicaid revenues. Six months later, that number had climbed to $2.9 billion.
Actual performance data.
Using first-year figures, the updated study also increased the projected eight-year economic impact of expanded Medicaid to $30 billion and the budget impact to a positive $820 million – even after the state match for Medicaid costs is phased in.
In the coming two-year cycle, governing the biennium for Gov. Bevin’s first budget, it’s a positive impact of $300 million.
His unsupported rhetoric aside, Kentucky can afford it.
Fortunately, the new governor’s proposed budget fully funds Medicaid expansion – although he says he’s going to seek federal waivers to create, quote, a “transformative program,” unquote.
So he’s begun to back off of some of his past extreme rhetoric.
Unfortunately, he says he still intends to destroy Kynect and move Kentucky to the federal exchange.
This even though it’ll cost $23 million to do so … even though we might have to repay the feds some money … and even though it would hurt Kentucky’s oversight capability, access to data and knowledge about the operation of the exchange.
Gov. Bevin says he just doesn’t believe the numbers that you, the researchers and experts, have come up with.
But I haven’t given up trying to convince him.
Tearing up a national model for political reasons just isn’t good policy.
By the way, those economic impact numbers in Deloitte’s report don’t include the societal impact of improved health on quality of life or economic capacity, or tangible things like worker productivity, school attendance and our collective public image.
I saw recently where spending on federal health-care programs has outpaced spending on Social Security for the first time.
That fact will be the subject of much anti-government rhetoric in the presidential campaign.
But let’s not lose sight of the impact of good health, and the huge financial value it brings.
This is an investment in so many other things.
And it’s making a difference in Kentucky.
Kyhealthnow’s recent year-end report provided indisputable, data-driven evidence that Kentucky was finally moving the needle on its most stubborn, long-term health challenges, statistics that haven’t improved in 25 years.
The dramatic increase in screenings and primary care visits had a lot to do with that.
And I predict that improvement will continue if we keep connecting our people with the health care they need.
So I commend all of you today for your commitment to health policy, to research that paves the way for improved collective health across our country.
Better health doesn’t happen from a single change, or because of a single person.
But together, we can continue the march toward a healthier future.