What Would Happen to Kynect if the Affordable Care Act Were Repealed?

Kynect cannot survive without the Affordable Care Act, according to its director and a Kentucky public health educator.The Affordable Care Act, commonly called Obamacare, has been a hot political topic since before President Obama signed it into law in 2010. The issue has been a leading point of contention between the leading candidates in Kentucky's high-profile Senate race.Senate Republican Leader Mitchell McConnell has repeatedly voiced his desire to repeal the ACA "root and branch" while also making claims that Medicaid coverage wouldn't be lost if the federal law were axed. In a debate earlier this month,McConnell called the ACA "the worst piece of legislation that’s been passed in the last half century,” but didn't elaborate on how Kynect could exist without the federal support. Democratic challenger Alison Lundergan Grimes has said she'd support changing the ACA but not repealing it.So, what would happen if the ACA were repealed?Carrie Banahan, Kynect's executive director, said Kynect would no longer be able to serve its purpose. "People would not be able to get subsidies if the Affordable Care Act were repealed and states could not have the Medicaid expansion," she said.The McConnell campaign disputes that the end of  the ACA would mean an end to Kynect. On Wednesday, a McConnell spokesman said in an e-mail: As you know, Medicaid existed before Obamacare. The state operated Medicaid before Obamacare. The state can continue to operate Medicaid after Obamacare. There were online health insurance marketplaces before Obamacare. There are several non-Obamacare insurance sales websites now that are not part of Obamacare. There can be online insurance sales without Obamacare. Obamacare did not create the ability to buy insurance online—people have been doing that for years. Obamacare did not create Medicaid. Medicaid has been available for nearly (50) years.The response does not address how Kentuckians under Kynect would be sustained financially.Glen Mays, professor of health services research at the University of Kentucky, said repealing the Affordable Care Act would have catastrophic consequences for people who are insured through Kynect. "If those two pieces were to go away--the Medicaid expansion and the private insurance coverage through the state exchange-- that would be catastrophic. That would certainly undermine the viability of the expanded health insurance market here in Kentucky," he said.During Kynect's first open enrollment period, 413,410 people enrolled. Of those, 330,615 people received Medicaid coverage. The remainder enrolled in a private health plan. People insured under Medicaid would immediately lose coverage, Mays said. He said prior to the ACA, Kentucky's lower income population didn't have affordable health care options.  The vast majority of people who signed up for private health insurance would lose their subsidies under a repeal, Mays said.  "They would suddenly find private health insurance to be out of reach financially without the premium subsidies and without the out of pocket protections that many of those Kentuckians are now receiving," he said.He said there will also be adverse economic effects. There has been an economic boost with nearly a half a million people gaining coverage and being able to access and pay for health care services.The marketplace has also attracted more insurers and made insurance options more affordable, which is helping to keep overall health insurance premiums lower and affordable both to employees and employers especially in the small employer market.  If health care-related stimulus were to suddenly halt, there would be a limiting affect on overall economic growth in the state."Health care employers, hospitals and physician practices are dominate employers. The job growth that has occurred over the last few years has been strongest in that health care sector and that would be weakened," Mays said. With the midterm elections a week away, the discourse surrounding the ACA may sway voters' decisions at the polls, Mays said."The Affordable Care Act as a piece of federal policy still remains very, very controversial and divisive in partisan politics  and we see that here in Kentucky just like we see that in other parts of the country," he said.However, Mays said there is also a local dimension to the ACA's implementation in Kentucky that is embodied in Kynect and its success.  "Obamacare may not be popular, but Kynect is much more popular in terms of the local implementation experience. It has less of the political baggage than the federal Obamacare," he said.  Meanwhile, at the national level, the question of whether the ACA will be repealed is switching to speculation of how it might be changed. On Wednesday, Vox's Ezra Klein wrote aboutone such possibilityto tweak the health care law.