Divided We Fall

November 15, 2015 7:30 AM

Kentucky counties with highest Medicaid rates backed Matt Bevin, who plans to cut Medicaid

Owsley County, one of the nation's poorest places [prev], neatly fit the trend. Nearly 1,000 of its 4,508 residents got health insurance after Democratic Gov. Steve Beshear established Kynect two years ago and expanded Medicaid to include people up to 138 percent of the poverty level, which is $16,105 a year for an individual. Newly insured people started to visit the Owsley County Medical Clinic on the outskirts of Booneville. They desperately needed medical care. Even by Kentucky's lax standards, Owsley has high rates of obesity, smoking and poor nutrition, and as a result, greater than normal incidences of cancer, heart disease and diabetes. Some patients wept with relief as longtime ailments finally were treated, clinic officials said. [...] The community's largest-circulation newspaper, the Three Forks Tradition in Beattyville, did not say much about Kynect ahead of the election. Instead, its editorials roasted Obama and Hillary Clinton, gay marriage, Islam, "liberal race peddlers," "liberal media," black criminals and "the radical Black Lives Matter movement."

Owsley County voted for Bevin, a Tea Party businessman who vowed to dismantle Kynect, by a 70-25 margin.

Last Week Tonight's pre-election piece on the Medicaid gap. Here's a direct link to the Kentucky portion. Especially noteworthy is the irony of Bevin's own checkered insurance history.

WDRB: Gov. Beshear urges Governor-elect Bevin to reconsider reversing health care reforms

WFPL: How Kynectors Help Kentuckians Navigate Signing Up for Health Insurance

WaPo: Kentucky’s newly insured worry about their health under next governor

Courier-Journal: Here are some questions and answers about Medicaid and kynect as Gov.-elect Matt Bevin gets set to take office

Elsewhere on MeFi:

In Appalachia the country is beautiful and the society is broken.
Abandoned by Coal, Swallowed by Drugs.
We Mapped the Uninsured. You'll Notice a Pattern.
Rising deaths among white middle-aged Americans could exceed AIDS toll
Other results from the off-year races

posted by Rhaomi (90 comments total)

Many of those people literally don't understand that the new healthcare benefits they were recently able to afford/qualify for came about because of "Obamacare", Kentucky's decision to rename it KyNect obviously was intentional to distance it from Obama, but at the same time obscured the source of the law's real benefits.

Then Jack Conway made literally no attempt to explain to these people Bevin's plan to pull those benefits away, because he was terrified to mention Obama's name; a not insubstantial percentage of KY voters/hate radio devotees would vote against anything approved by Obama at literally any cost to themselves, they hate him that much. Conway vastly overestimated the percentage of those people who would vote for him instead if he just promised to sue the EPA again (which was always 0%), but Obama derangement is a real thing in most of Kentucky outside of Lexington and Louisville. You'd like to hope that losing access to much needed healthcare would open their eyes, but I wouldn't hold my breath that many of them will pull the level for Clinton or anyone else with a D next to their name as long as their only source for news comes from Bevin lovers Rush Limbaugh and Sean Hannity and no Democrats in Kentucky are willing to run ads that explain the issue, rather than how much they too, hate Obama.
posted by T.D. Strange at 7:48 AM on November 15, 2015 [35 favorites]

I had healthcare through Kynect before I left KY, and it was great and I needed it. I feel awful for all the people who will lose it. It is a complex and complicated place.
posted by still bill at 7:48 AM on November 15, 2015 [5 favorites]

The willingness or even eagerness by which people vote against the health care that directly benefits them is to me a genuine mystery.
posted by Dip Flash at 7:51 AM on November 15, 2015 [15 favorites]

Lack of education in places like this isn't by accident.
posted by jonmc at 7:53 AM on November 15, 2015 [55 favorites]

4508 people. 1000 on Kynect. 823 voted total. It's possible that not a single person on Kynect voted against it.
posted by miyabo at 7:56 AM on November 15, 2015 [90 favorites]

To Bevin

(凸ಠ益ಠ)凸

Regards, from civilisation.
posted by lalochezia at 7:58 AM on November 15, 2015 [13 favorites]

"Because in reality, it has been increasingly proven that if you have skin in the game, if you have a vested interest in the outcome, you are more likely to make wise decisions that ultimately effect your health. Studies have shown that people on Medicaid have worse health outcomes than people who have no insurance at all," Bevin said at a town hall forum in September.

There should be some kind of mechanism for holding politicians accountable, legally and monetarily, for making shit up when it comes to people's lives, especially when you invoke "studies" that don't exist. This is fundamentally no different than sending young soldiers to die over yellow cake uranium.

Democracy is so abusable when you have an electorate that doesn't appear to think critically and propaganda is the only "journalism." The good freedom loving people of rural Kentucky would be shocked to learn how closely their election mirrors elections in places like North Korea and Iran.
posted by Slarty Bartfast at 8:04 AM on November 15, 2015 [28 favorites]

It's possible that not a single person on Kynect voted against it.

I read a quote from one of the Republicans somewhere about how they planned to answer the medicaid issue, "People on Medicaid don't vote". Sorry I can't remember the source, but it's true. Low income voters generally are the least likely to turnout, for a variety of reasons, some probably legitimate and some not so much. I personally know several friends who are servers in Kentucky, and all either benefit from Kynect or probably would if they bothered to sign up, and I wouldn't really want to see the breakdown on how many of them actually made it to the ballot box vs posted something anti-Bevin on Facebook.

Is that an argument for expanded voting options? I think so, but also it's proof that sometimes you get the government that you don't bother to vote against.
posted by T.D. Strange at 8:05 AM on November 15, 2015 [10 favorites]

4508 people. 1000 on Kynect. 823 voted total. It's possible that not a single person on Kynect voted against it.

This is potentially a significant point, but it is not entirely clear how significant. It really depends on how many eligible voters live in the county. Are there numbers on what the turnout was, as a proportion of eligible voters? I'm not immediately seeing them in the links.

The issue of low electoral turnout among those who are the victims of punishment by politicians seems like a potentially more important issue than the question of the extent to which people vote against their interest. Particularly in light of the various soft disenfranchisement measures being put in place.
posted by howfar at 8:06 AM on November 15, 2015 [5 favorites]

The cause is simple... propaganda works, and convinces the people to blindly act against their own interests.

"Hypocrisy is the characteristic feature of the dying bourgeois epoch." -- Goebbles, 1926
posted by MikeWarot at 8:14 AM on November 15, 2015 [5 favorites]

Mod note: A few comments removed. Please actually say what you mean if you're making a reference, because the odds of enough people getting it to positively influence the reaction are low. Thanks.
posted by restless_nomad (staff) at 8:14 AM on November 15, 2015 [2 favorites]

What's the matter with Kansas Kentucky?

Frank applies his thesis to answer the question of why these social conservatives continue to vote for Republicans, even though they are voting against their best interests. He argues that politicians and pundits stir the "Cons" to action by evoking certain issues, such as abortion, immigration, and taxation. By portraying themselves as champions of the conservatives on these issues, the politicians can get "Cons" to vote them into office. However, once in office, these politicians turn their attention to more mundane economic issues, such as business tax reduction or deregulation. Frank's thesis goes thus: In order to explain to the "Cons" why no progress gets made on these issues, politicians and pundits point their fingers to a "liberal elite," a straw man representing everything that conservatism is not. When reasons are given, they eschew economic reasons in favor of accusing this elite of simply hating America, or having a desire to harm "average" Americans. This theme of victimization by these "elites" is pervasive in conservative literature, despite the fact that at the time conservatives controlled all three branches of government, was being served by an extensive media devoted only to conservative ideology, and conservatives had won 6 of the previous 9 presidential elections.

posted by andoatnp at 8:17 AM on November 15, 2015 [23 favorites]

The cause is simple... propaganda works, and convinces the people to blindly act against their own interests

I think it's more complicated than that. People often buy into conservative rhetoric because they don't envision themselves as needing the services of the government, when they clearly do need them, and use them all the time.
posted by roomthreeseventeen at 8:19 AM on November 15, 2015 [14 favorites]

I have a lot of grateful patients who had gone a long time without access to health care before Obamacare and the topic of "What will happen to me if the Republicans win and they take away my health care?" comes up not infrequently. I always try to reassure them by saying not to worry, the ACA has been so resoundingly successful that the backlash from taking away the Medicaid expansion would make this politically impossible. And maybe here in Washington state that's true. But now I can tell them to just watch what happens in Kentucky. One thing I do appreciate about our constitution is that we have 50 democracy laboratories to conduct experiments. I feel bad for the sick unemployed coal miners, but really not all that bad.
posted by Slarty Bartfast at 8:19 AM on November 15, 2015 [4 favorites]

It's possible that not a single person on Kynect voted against it.

There is no sum of money that I would bet on that possibility. I would not bet your money on it, simply to keep myself from knowing that I made such a bet.
posted by Etrigan at 8:22 AM on November 15, 2015 [7 favorites]

Asking "why didn't they vote" is a popular response to this mess. IMHO, it furthers too much divisive thinking. Urban liberals ask this about people living in the counties, further othering them, rather than building any solidarity. It also tacitly absolved the KY Democratic Party of any responsibility for the results of this election.

When you look at the raw numbers, you'll notice that down ballot candidates received more votes than the Conway/Bevin race. Why is that? Why it is that I have yet to meet a single person who was excited about the prospects of Governor Conway. When you run candidates because "they've earned their shot" or whatever, you will lose. Why didn't they run a better race? Why didn't they actually explain these issues?
posted by Burgoo at 8:22 AM on November 15, 2015 [20 favorites]

The cause is simple... propaganda works, and convinces the people to blindly act against their own interests

It's easy to stir up people's emotions and make them blind to logic and reason. I think it's our default state, to be driven by emotions.
posted by Brandon Blatcher at 8:22 AM on November 15, 2015 [4 favorites]

4508 people. 1000 on Kynect. 823 voted total. It's possible that not a single person on Kynect voted against it.

I mean, I guess, but that assumes that people don't care at all about their siblings, kids, parents, neighbors, friends, etc., and I don't think that's true. My hunch is that every single voter in Owsley County cares about someone who is benefiting from Kynect and would be sad if that person suffered because they lost their health care.
posted by ArbitraryAndCapricious at 8:29 AM on November 15, 2015 [5 favorites]

I feel bad for the sick unemployed coal miners, but really not all that bad.

Gee, I'm glad my family members are a neat little experiment for you.

Maybe someday something will happen in your neck of the world so I can return your complete lack of empathy with interest.
posted by winna at 8:30 AM on November 15, 2015 [62 favorites]

I think there is something inherently democratic about these people who are on Medicaid voting for people who are going to take away Medicaid, if they are anything like some of my more conservative relatives: Afraid that if we give the have-nots things like medical care, the haves will have to pay for it, thus the haves stand to lose something, and the have-nots will get something.

Instead, they would rather EVERYONE lose something. So nobody gets medical care! That's as fair as you can get!
posted by nushustu at 8:38 AM on November 15, 2015 [5 favorites]

Asking "why didn't they vote" is a popular response to this mess. IMHO, it furthers too much divisive thinking. Urban liberals ask this about people living in the counties, further othering them, rather than building any solidarity. It also tacitly absolved the KY Democratic Party of any responsibility for the results of this election.

There are plenty of "Ugggh, why don't these morons vote?" ways to say it, but there's also "Why didn't they vote, and how can we get them to vote next time?", the answer to which may well include "Kicking the KY Democratic Party in the ass and getting them to realize that there's work to be done."
posted by Etrigan at 8:42 AM on November 15, 2015 [16 favorites]

You'd like to hope that losing access to much needed healthcare would open their eyes

If losing the healthcare becomes a sufficient blip on the radar to be a threat against the GOP such that it will make their voting ranks consider turning, the GOP will simply blame Obama and Obamacare for their worsened outcome. And voters will believe.
posted by Karaage at 8:43 AM on November 15, 2015 [3 favorites]

If propaganda works so effectively, why won't the pro-health care forces use it? If you can't demonize a demonic force like todays proto-fascist right, you're a political moron and/or corrupt. (Oops, I accidentallly just described the Democrat Party since Reagan.)
posted by mondo dentro at 8:46 AM on November 15, 2015 [9 favorites]

The inefficacy of Republicans in places like Kentucky in pursuing social conservative policies is a bad rap. Maybe 30 years ago there were some squishes, but do you think that current Kentucky Republicans would hesitate an instant to do anything on the social conservative agenda that the Supreme Court would allow them? And feckless as he was, George W. Bush went 2-2 in avoiding rogues in his appointments to the Supreme Court, so you have to go back more than 25 years to find a Republican Supreme Court appointment that ended going rogue (Souter). For them, voting Republican has been the best they could do.

What will be fascinating is if Trump gets the nomination. His track record on social conservatism is zero (negative, really), at best nominally religious (and mainline Protestant at that) himself and one his kids is Jewish. Maybe these working class social conservatives will vote for him on immigration, but going to be hard to see why he's compelling on abortion or gay marriage.
posted by MattD at 8:46 AM on November 15, 2015

People often buy into conservative rhetoric because they don't envision themselves as needing the services of the government, when they clearly do need them, and use them all the time.

If you accept the framing narrative that describes the poor as lazy and shiftless, pretty much everything else follows. I'm certainly not lazy and shiftless. Therefore I'm not poor. I'm middle class. People with less than me, they're poor, and they want to take money out of my pocket so fuck them.
posted by Naberius at 8:52 AM on November 15, 2015 [19 favorites]

It's tempting, in situations like this, to think of a small child who won't stop trying to do something bad because the parents keep stepping in to prevent the bad thing from happening. One feels as if learning behavior won't happen until people feel some pain and make a connection.
posted by LastOfHisKind at 8:55 AM on November 15, 2015 [5 favorites]

Naberius, yeah, I agree with that. It's frustrating because then in the next sentence they'll tell you that they can't afford to send their kids to college because of the damn Democrats in the White House.
posted by roomthreeseventeen at 8:56 AM on November 15, 2015

It's tempting, in situations like this, to think of a small child who won't stop trying to do something bad because the parents keep stepping in to prevent the bad thing from happening. One feels as if learning behavior won't happen until people feel some pain and make a connection.

I get that it's tempting, but it's also shitty and condescending and I wish you wouldn't do it.
posted by ArbitraryAndCapricious at 8:59 AM on November 15, 2015 [39 favorites]

I think it's our default state, to be driven by emotions.

I think it's our only state--thinking just sort of rides on top of emotions, barely holding on and trying to convince us it's in charge and making the decisions, with only occasional successful influence.
posted by LooseFilter at 9:02 AM on November 15, 2015 [4 favorites]

I think it's more complicated than that. People often buy into conservative rhetoric because they don't envision themselves as needing the services of the government, when they clearly do need them, and use them all the time.

Culture war politics is directed towards people who live close enough to the bottom 20% that they can smell the desperation and hopelessness of being a disposable human being. Conservatives will say, look this country is in crisis, but if you are white, if you are a man, if you aren't a slut, then you can be a full member of society. Take single mothers:

conservatives: if we had traditional values, mothers would be taken care of by their husbands.

Democrats: birth control, abortion, and college tax credits.

Mind you, this isn't about who single mothers will vote for. This is about (a wedge issue for) people looking at the desperation of single women with children in the bottom 20% from the next rung up. Marriage and family are absolutely the bedrock of social welfare in this country. If you are in a household making around the median, your welfare and lifestyle is absolutely dependent on maintaining two incomes in a marriage, especially if you want to have children. On the flip side, if you are waiting for that next promotion in order to take time off to have a kid, how do you feel about paying taxes so iiresponsible young women can hang out at home? How exactly were the Clintons able to kill welfare for poor mothers? Next up: marriage.

Liberals say marriage is about love. But for many many people, marriage is about having a wedding, buying a house and having children. I mean, most people are urged to hold off getting married until they can afford at least one of those things. The result of which is that, given the state of the economy over the last 40 years, there are lots of people who wish they could get married but feel like they can't afford it. or see this in their children.

Conservatives: marriage is threatened in this country (by gays, islam, fluoride in the drinking water etc.)

Democrats: haha. what? why do you hate our freedom?

The conservative culture war is about misdirection, resentment and hate. But it starts with acknowledging that our society is in crisis and offering complete (fantasy based) solutions. Democrats pretend everyone is going to be a college educated professional and offering scraps from the table.

That's what's the matter with Kansas.
posted by ennui.bz at 9:02 AM on November 15, 2015 [25 favorites]

A point I will continue to make over and over in cases like these is that even a 70-25 landslide in a county means that one in four people voted against this guy. So speaking in a blanket sense about how "they" voted is.... Well, you can find plenty of people who voted the other way by, oh, say... turning your head slightly to one side or the other.
posted by DirtyOldTown at 9:09 AM on November 15, 2015 [13 favorites]

I know a guy who told me that he liked the Affordable Care Act, but didn't like Obamacare. He refused to believe that they were the same thing.
posted by Slinga at 9:12 AM on November 15, 2015 [23 favorites]

This is fundamentally no different than sending young soldiers to die over yellow cake uranium.

. . . for which also no one gets held accountable.
posted by birdhaus at 9:15 AM on November 15, 2015 [3 favorites]

Take single mothers:
conservatives: if we had traditional values, mothers would be taken care of by their husbands.
Democrats: birth control, abortion, and college tax credits.

You somehow managed to omit "Medicaid" from the relevant policies defended by the Democratic Party, which is impressive as it's the subject of this post.
posted by Xavier Xavier at 9:16 AM on November 15, 2015 [6 favorites]

Funny how "Let's take away healthcare from the poor" isn't an actionable death threat.
posted by Pope Guilty at 9:23 AM on November 15, 2015 [13 favorites]

When they vote, single women, including single mothers, overwhelmingly vote for Democrats. The problem is that they often don't vote, and they especially don't vote in non-presidential elections. My experience is that they often hold themselves to a really high standard for being informed, and they say that they would vote for Democrats if they voted, but they don't feel like they have time to research the issues sufficiently. I almost never hear that from men: they either go with their gut or tell me that they listen to some trusted authority. (One guy asked me if the NRA endorsed my candidate, because he always voted for who the NRA endorsed. I had a moment of ethical crisis where I realized that I could lie and he would probably vote for my candidate, but I decided I couldn't do that and told him that I didn't know who the NRA was endorsing but I could give him lots of good reasons to vote for my candidate. He told me that he agreed with everything I said, but he would have to check with the NRA before deciding who to vote for. Sigh.) I think that it takes a fair amount of confidence to vote for someone whom every authority in your life is telling you is Satan, and women often don't have that kind of confidence.
posted by ArbitraryAndCapricious at 9:24 AM on November 15, 2015 [24 favorites]

Funny how "Let's take away healthcare from the poor" isn't an actionable death threat.
Why would it be? To Republicans, the poor aren't people.
posted by xedrik at 9:25 AM on November 15, 2015 [4 favorites]

When they vote, single women, including single mothers, overwhelmingly vote for Democrats

Conditional on them being low income and rural and white, this relationship attenuates.
posted by MisantropicPainforest at 9:25 AM on November 15, 2015 [1 favorite]

America, The Fucked.

Yeah, I know globalism has turned everything to shit everywhere, but the State system combined with the two party system and systematic dismantling of decent public schooling has led the US down a path I'm not sure they can get off.

We seem to be at a point where we are trying to limit the damage the US can do to other states when they implode. Good luck with that, Canada. Mexico might actually do better, since they can coordinate with the Caribbean trade states for a little bit.

Until the US military Junta takes over.
posted by clvrmnky at 9:26 AM on November 15, 2015

if you have skin in the game

What a sad and fitting turn of phrase in this context. The idea that your money is more significant than your real actual flesh.
posted by Meatbomb at 9:28 AM on November 15, 2015 [15 favorites]

Well, in the real world, not in tinfoil hat land, the fact that these poor people in rural Kentucky even have a government mandated healthcare program represents huge progress.
posted by MisantropicPainforest at 9:34 AM on November 15, 2015 [3 favorites]

When a democracy gets 20% turnout voter the result, whatever it is, is exactly what is deserved. Quality democracy requires active participation at many levels. Fundamentally it also requires ready and free access to reasonably objective information as well as a population educated enough to know what to do with said material. Failed model, hard to imagine a reasonable alternative.
posted by jcworth at 9:38 AM on November 15, 2015 [2 favorites]

You somehow managed to omit "Medicaid" from the relevant policies defended by the Democratic Party, which is impressive as it's the subject of this post.

Here's the funny thing about the ACA. If you are poor enough to qualify for the medicaid expansion (and your state has expanded it) then you can get, pretty much, free or close to free medical care, if you can find doctors and clinics that will treat medicaid patients. If you can afford a subsidized "Bronze" plan, you may only be able to find a plan with a very high deductible ie:

Patricia Wanderlich got insurance through the Affordable Care Act this year, and with good reason: She suffered a brain hemorrhage in 2011, spending weeks in a hospital intensive care unit, and has a second, smaller aneurysm that needs monitoring.

But her new plan has a $6,000 annual deductible, meaning that Ms. Wanderlich, who works part time at a landscaping company outside Chicago, has to pay for most of her medical services up to that amount. She is skipping this year’s brain scan and hoping for the best.

Do you think the Republicans targeted the medicaid expansion simply out of cruelty? Or because the Democrat's signature health care plan, the ACA itself pits the middle against the bottom, and the Republicans knew they could exploit that?

The Republicans actually understand class politics in the US.
posted by ennui.bz at 9:39 AM on November 15, 2015 [19 favorites]

Dip Flash: "The willingness or even eagerness by which people vote against the health care that directly benefits them is to me a genuine mystery."

People will often be single issue voters for some other issue.
posted by Mitheral at 9:48 AM on November 15, 2015 [8 favorites]

Yeah, if you can only afford a Bronze plan I can sure as shit see why you'd be resentful about being forced to pay for something you can't actually use.
posted by desjardins at 9:49 AM on November 15, 2015 [3 favorites]

Except they can and do use it, since many routine checkups are covered.
posted by MisantropicPainforest at 9:51 AM on November 15, 2015 [3 favorites]

miyabo: "4508 people. 1000 on Kynect. 823 voted total"

jcworth: "When a democracy gets 20% turnout voter the result, whatever it is, is exactly what is deserved."

Remember residents include children, non-citizen immigrants and people restricted from voting. Turn out was a lot higher than 20%
posted by Mitheral at 9:53 AM on November 15, 2015 [7 favorites]

This kind of thing has gotten me to the point where I'm more or less convinced that the US's days as a going concern are numbered. All that will be left, barring a Somalia-like basket case state is a giant walled colony from which human worker ants and brood sows will be periodically selected to perform labor for the increased enrichment of the overclass.
posted by Emperor SnooKloze at 9:59 AM on November 15, 2015 [1 favorite]

MisantropicPainforest, we've had questions on this very website from people who were charged for things that should have been 100% covered. It happens constantly - the office visit is covered, but if you get a urine test, watch out! $100.
posted by desjardins at 10:00 AM on November 15, 2015 [3 favorites]

I mean, I have a master's degree and I can't fucking figure out medical billing. It's a trainwreck. I went to the doctor once when I was on the bronze plan for a suspected UTI. $300. I could absorb that but that would destroy someone in a more precarious financial state.
posted by desjardins at 10:02 AM on November 15, 2015 [12 favorites]

There is no such thing as medical billing. It's all smoke and mirrors and negotiations.
posted by roomthreeseventeen at 10:03 AM on November 15, 2015 [14 favorites]

Except they can and do use it, since many routine checkups are covered.

This is what I mean by table scraps. Why should people on 'Bronze' plans be grateful and enthusiastic when they can see people on the Gold plans and people on Medicaid not having to worry about whether their insurance classifies a doctor's visit as a routine checkup or not?

The politics of this are crystal clear. The ACA could have fixed it by making sure the minium standard included affordable deductibles. But this would have needed to be paid for by either raiding Medicare, Medicaid, or even higher taxes on 'Gold' plans, taxes which would hurt low income, high benefit workers eg. the unions. The ACA pits all of these groups against eachother rather than *for* the ACA.
posted by ennui.bz at 10:04 AM on November 15, 2015 [6 favorites]

Mitheral: Remember residents include children, non-citizen immigrants and people restricted from voting. Turn out was a lot higher than 20%

Just to add some clarification & an additional data point: approximately 5.5% of Kentuckians are permanently disenfranchised as a result of having a felony (even a Class D) on their criminal record. Kentucky is one of only four states, I believe, that permanently disenfranchises individuals who have committed a felony. This disproportionately impacts lower-income individuals.

Source: https://www.kftc.org/campaigns/voting-rights-amendment
posted by pecanpies at 10:20 AM on November 15, 2015 [15 favorites]

Well, folks, I'm your Huckleberry. I live in KY and will be making a KYNect-ion of my own here soon.

Got a letter last week from my employer that pushed me out of health benefits for next year. My union failed to inform me (and thousands of others) of changes in the new contract which left many of us under the new threshold for eligibility. While I despise Bevin and know that my employer considers me as "meat" and not human, I definitely didn't think that my union would let me down through simple negligence and apathy. I assume ultimate responsibility but damn, it was a kick in the rump.

What's the matter with Kentucky? It's the feudalism, stupid.
posted by CincyBlues at 10:20 AM on November 15, 2015 [20 favorites]

Also a native, lifelong Kentuckian here and I appreciate that this thread, with few exceptions, has not just devolved into another #LOLKentucky mess. Thank you.
posted by pecanpies at 10:25 AM on November 15, 2015 [11 favorites]

Lack of education in places like this isn't by accident.

As long as education is tied to property taxes, the poor will get a substandard education.

Do other countries do this?
posted by el io at 10:26 AM on November 15, 2015 [10 favorites]

(sorry for this derail, but since I left an open question, I thought I'd give an answer).

No, other countries do not do this.

To my knowledge, the U.S. is the only nation to fund elementary and secondary education based on local wealth. Other developed countries either equalize funding [across the state] or provide extra funding for individuals or groups felt to need it. In the Netherlands, for example, national funding is provided to all schools based on the number of pupils enrolled, but for every guilder allocated to a middle-class Dutch child, 1.25 guilders are allocated for a lower-class child and 1.9 guilders for a minority child, exactly the opposite of the situation in the U.S. where lower-class and minority children typically receive less than middle-class white children.

From What Research Says About Unequal Funding for Schools in America (warning: .doc file)
posted by el io at 10:32 AM on November 15, 2015 [36 favorites]

The willingness or even eagerness by which people vote against the health care that directly benefits them is to me a genuine mystery.

It's not a mystery. And it isn't simply a case of people voting against "their own best interests." In Owsley County, 66% of the population was on expanded Medicaid, but 70% of the electorate voted for Bevin, the anti-Medicaid candidate. This means that a non-trivial percentage of Kentucky residents were simultaneously Medicaid beneficiaries and Bevin voters at the same time. They even quote a woman named Lisa Botner in the article who fits both of those criteria.

The political case for the Affordable Care Act was that, if Obama could point to a successful program that expanded what was left of New Deal/Great Society welfare state and show that it had tangible benefits to Americans of all economic classes, then Obama and, by extension, the Democratic Party could make inroads into poorer "red state" constituencies who would benefit from the new programs. Unfortunately, the opposite seems to be true. According to a political scientist quoted in the main article,

At Transylvania University, political scientist Andrea Malji said she has crunched state data and found a "99 percent confidence level" between the counties' Medicaid enrollment levels and their gubernatorial choices. The larger the Medicaid numbers, the more likely they were to back Bevin, she said. The lower the Medicaid numbers, the more likely they were to favor the Democratic nominee, Attorney General Jack Conway.

I suspect somebody from the MeFi peanut gallery who never reads the frickin' articles is going to say, "Correlation is not causation," at this point. The problem is not that the correlation can only provide partial evidence of causation. The problem is that the correlation is in completely the opposite direction from what liberals would expect and completely in opposition to the political hypothesis underlying Obamacare. Kentucky voters are not voting Republican in spite of being on Medicaid, but quite possibly because they are on Medicaid.

When Bill Clinton proposed his health care program in 1993, the right-wing pundit William Kristol wrote a strategy memo that stated,

...the long-term political effects of a successful Clinton health care bill will be even worse--much worse. It will relegitimize middle-class dependence for "security" on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.

Obama had to be thinking on the same lines, but unlike Kristol, he assumed that the passage of his health care program would be a political boon for him. The Democrats did not win a newfound reputation as "the generous protector of middle-class interests." Instead, the issue of health care became racialized. According to research by the political scientist Michael Tesler (cite), racial attitudes became more predictive of people's views on health care politics than at any time in the past twenty years. The racial divide in opinion polls on health care issues was 20 percentage points greater in 2009 than it was when Bill Clinton proposed his plan in 1993. The Democrats got no political credit for passing the biggest health care reform in a generation, because a black man's name was attached to it. Don't believe me? Check out this Jimmy Kimmel segment where several white people say on camera that they prefer the Affordable Care Act to Obamacare, without realizing that the two are exactly the same thing.

In addition, you don't necessarily need social issues to explain the pattern of votes in Kentucky about Bevin and Medicaid expansion. Instead of feeling gratitude for getting a successful government benefit program that can literally extend their life span, many poor white Kentucky voters are instead filled with ambivalence and self-hatred about it, because they've been told all their lives how they're supposed to self-made independent individualists, not dependent on "the government."

Finally, there was complete malpractice by the Kentucky Democratic Party in failing to educate the electorate about the connection between Obamacare, Kynect, and improved healthcare outcomes in Kentucky and why voting for the Democratic Party was absolutely essential to keeping it that way. Neither Alison Lundergan Grimes in her 2014 Senate rate or Jack Conway in his 2015 gubernatorial bid aired any ads that made the connection between Obama and the success of Kynect. And if Grimes and Conway aren't going to help the voters make that connection, when they have a clear political self-interest in doing so, why should we expect anybody else to do so? You can't expect the Republicans to talk straight on the issue. You can't expect the Kentucky state educational system to have given people enough of an education in critical thinking and civics to expect the median voter to draw connect the dots between Obama and Kynect. And you certainly can't expect the local Kentucky media to do so, especially when most of the local TV stations and newspapers are controlled by local business interests with their own right-wing hobby horses they'd prefer to emphasize.

People can't understand why people didn't draw the connection between the Democrats and keeping their own health care? I can't understand how they could.
posted by jonp72 at 10:38 AM on November 15, 2015 [43 favorites]

I live in a state that not only didn't expand Medicare, they cut the chips program for pregnant women and kids. (While simultaneously closing almost all women's health centers.) A friend of mine is a single mom with two kids, who had to buy aca coverage because fines. Her deductible is 8 months worth of rent. She hasn't been to a doctor or dentist in years. There's no such thing as a fully covered office visit, and she can't afford to have a surprise $300 "oh we ran these tests" bill.

Medical care in the US is a tragedy and it's not going to get better anytime soon.
posted by SecretAgentSockpuppet at 10:39 AM on November 15, 2015 [11 favorites]

I tallied it up. States with two republican senators have 82 out of 100 poorest countries in America. Not saying the senators are directly responsible, just that that's how they vote.
posted by dances_with_sneetches at 11:12 AM on November 15, 2015 [13 favorites]

Regarding the Bevin quote, can we institute a moratorium on the use of "skin in the game" (like Martin O'Malley's attempt to squash "boots on the ground")? I mean these people's LITERAL SKIN (as well as the rest of their bodies) is on the line and it's disgusting to say that they need to feel "invested" in their medical decisions.
posted by dhens at 11:13 AM on November 15, 2015 [10 favorites]

I tallied it up. States with two republican senators have 82 out of 100 poorest countries in America. Not saying the senators are directly responsible, just that that's how they vote.

And the poor in those states are more likely to vote for democrats than the rich in those states.
posted by MisantropicPainforest at 11:15 AM on November 15, 2015 [1 favorite]

Not to defend the foolishness too much, but identity politics can be a powerful thing for people, especially in poorer populations. Sometimes more important than health care.
posted by destro at 11:15 AM on November 15, 2015 [4 favorites]

can we institute a moratorium on the use of "skin in the game"

Whenever someone uses this phrase, I immediately know they want me to sacrifice my skin to preserve theirs.
posted by Steely-eyed Missile Man at 11:27 AM on November 15, 2015 [11 favorites]

"That's the problem with poor people: they still have some of their skin."
posted by Rhaomi at 11:35 AM on November 15, 2015 [4 favorites]

"I do not intend to re-enroll people at the same level going forward," Bevin told reporters several days after his election. "There is not going to be a continuation of enrolling people at 138 percent of the poverty level. That is not going to happen."

Yeah! That'll show those lucky duckies!
posted by dhens at 12:01 PM on November 15, 2015 [1 favorite]

4508 people. 1000 on Kynect. 823 voted total. It's possible that not a single person on Kynect voted against it.

According to this, the number of registered voters in Owsley County was 3,646 as of 5/20/14.

823 people voted in this election. 580 of those voted for Bevin. So 580 out of 3,646 expressed a clear preference for Bevin.

It seems pretty clear that the issue is not so much people voting against their own interests as it is getting people to vote at all. There must be ways to do get people out and it should be a priority for Democrats, even if there are 2x as many registered Republicans as Democrats in Owsley County. Especially since there are 2x as many registered Republicans as Democrats. I genuinely don't understand why they don't do this.
posted by maggiemaggie at 12:21 PM on November 15, 2015 [3 favorites]

There was a viable third option in this race. A person who had actual plans for Healthcare, Education and everything else that KY needed. But well the main parties made sure that he was only in one debate due to 'poor polling numbers' (They used polling weeks where he was running low and then when he was running high the rules somehow changed.)
posted by 922257033c4a0f3cecdbd819a46d626999d1af4a at 12:22 PM on November 15, 2015 [5 favorites]

It seems pretty clear that the issue is not so much people voting against their own interests as it is getting people to vote at all. There must be ways to do get people out and it should be a priority for Democrats, even if there are 2x as many registered Republicans as Democrats in Owsley County. Especially since there are 2x as many registered Republicans as Democrats. I genuinely don't understand why they don't do this.

Same here! When only 20% of people are voting, the problem is not a failure of personal moral responsibility, there is something more systemic or structural happening. I want to know so much more about the people who don't vote. Do they not believe their vote will have an effect? Do they hold the entire system in contempt? Are they just totally apathetic? Do they hate the candidates they're offered? Do they think both sides serve the same corporate elite and it doesn't make any difference? Does the Democratic party really care about driving turnout among these people? It seems like it would be their best hope for electoral success and yet year after year, I see establishment Democrats making almost no credible efforts toward increasing turnout and reaching those people who don't vote and aren't already politically engaged.
posted by dialetheia at 12:55 PM on November 15, 2015 [2 favorites]

Bernie is trying to explain engage the non-voters, it doesn't seem to be doing much for him. I continue to hear the tired electability strawman.
posted by askmehow at 12:59 PM on November 15, 2015 [4 favorites]

Not to detail the thread, but when you are poor and perhaps ill-informed about how the world works as many middle and upper class people are due to their easy access to education and the Internet, your allegiance to a familiar set of values and cultural tropes is something you cling to as one a few stable touchstones in an unpredictable and dangerous economic environment. The cultural right is masterful at plugging into these tropes and tagging their opponents with neurologically driven components of disgust, shame and rage.
You can go on any liberal site, such as Salon.com and the see the same thing. The right-wing pols on there are portrayed as buffoons or dangerous tools. On a conservative site, the left wing pols are portrayed as an inch above pirahnas and flesh eating bacteria. Perhaps 3/8's of an inch.
Go watch some hit-piece video on Obama or the recent whack job on Planned Parenthood. Completely bypasses the frontal cortex.
The Democrats and liberals really don't seem to get this. Their ideological opponents are ruthless and unyielding. They are programming their audiences with disgust and rage at the opposition.
It has nothing to do with logic, economic reality or intelligence.
posted by diode at 1:08 PM on November 15, 2015 [18 favorites]

There are a lot of reasons to not vote--or even consider voting--when you live in rural and poor KY, WV or any other similar area. A lot.
posted by still bill at 1:35 PM on November 15, 2015 [1 favorite]

Agreed. The Left has lost the arms race of semantics and mimetic neural programming.
posted by SecretAgentSockpuppet at 1:36 PM on November 15, 2015 [6 favorites]

It's not even NLP-levels of programming. It's branding/marketing levels of programming. Trump's slogan is "Make America Great Again", which is fantastic. Trump talks about things he's going to do, powerfully and confidently, even if those things are horrifying. Hillary's slogan is "Hillary for America," which isn't exactly going to convince anyone that's not already on board with her. Most of her talking points have been...how great she is, which is the same thing as her slogan. Obviously we're in primary season and so it's tailored to the base, but the difference between the two is stark. Maybe her polling shows you either like her or hate her so she's sticking to that, but it's quite a contrast from Obama's brilliant campaigns on "Hope" and "Change."

As for why the left isn't as successful, they aren't great at identifying things that drive people to the polls for their side and making them into do-or-die issues. The Republicans are excellent at mobilizing their base around a core issue, making it seem urgent, and then people vote for Republicans while they're in the booth. The Democratic Party...basically dismantled the Obama for America machine that drove most of their turnout and don't seem much interested in continuing it.

Most of the leftists I know are far more focused on their Facebook and Twitter campaigns than driving voter turnout. The reaction is usually something like "But i posted all those memes! Twitter activism works! You're being ableist if you say people need to get out and sign up voters because many people can't leave the house!"

And there's also a real unwillingness to engage with the existing mechanisms of power. Ten people can show up to a Democratic Party meeting in most places I've lived and become a local power bloc. The Republicans have excellent local machines, running people for offices nobody much cares about to get them political experience, moving them through the minor leagues of local politics until they're ready for The Show. Even when I lived in blue-leaning areas, there were tons of obscure offices where your choice was the Republican running unopposed. That's how you get Texas school boards approving textbooks calling slaves "workers," because the left wants to run for President and institute full communism now, not serve on the local school board.
posted by Ghostride The Whip at 1:58 PM on November 15, 2015 [26 favorites]

You Can't Tip a Buick said this about the Iowa Caucus over in the Democratic debate thread:

Basically, you have to think of a campaign in a caucus state as less like a political campaign and more like a military campaign — your goal is to get more soldiers, and better organized soldiers, and better equipped soldiers, to a specific location at a specific time than your rivals can. Sure, the "battle" you're sending these soldiers involves winning control of a debate process rather than shooting bullets at each other, but it must be understood in military campaign terms — you're asking people to organized to do something that miserable that no rational person would ever want to do.

I feel like it applies across the board to state and local politics. You need strong, organized leadership to get people to care and to get out the vote especially when the other party is more popular in your state. It's cliche as hell but..."I am not a member of any organized political party. I am a Democrat." I'm sick of low turnout being blamed on voters when the party never seems to uphold their side of the bargain.
posted by Drinky Die at 3:37 PM on November 15, 2015 [2 favorites]

Matt Bevin already backing down on pledge to repeal Obamacare according to Daily Kos. Quoting Politico: "Even before the votes were cast, Bevin had started hedging his repeal bet, saying he would not take coverage away from people who have it. He can give the health law in his state a more conservative veneer. But he can’t scrap it completely..."

Daily Kos: "Audrey Haynes, secretary for the state Health and Family Services division, says that enrollees have been calling Kynect—the state's system—to find out if they can keep their coverage next year. The help line for Kynect has had to change its script to reassure customers that they'll still be covered. Imagine the calls that would go to the governor's office if those people were kicked out?"
posted by OnceUponATime at 4:25 PM on November 15, 2015 [5 favorites]

Then Jack Conway made literally no attempt to explain to these people Bevin's plan to pull those benefits away, because he was terrified to mention Obama's name; a not insubstantial percentage of KY voters/hate radio devotees would vote against anything approved by Obama at literally any cost to themselves, they hate him that much.

Then Jack Conway deserved to lose, and lose big. Because Jack Conway failed to grasp a very simple concept -- a not insubstantial percentage of KY voters/hate radio devotees would NEVER VOTE FOR HIM FOR ANY REASON ON EARTH no matter how much he pandered in their direction. He could go door-to-door giving complementary money and handjobs while his opponent sodomized a dead goat on live TV and these people would still pull the R lever.

You're not going to Blue Dog your way to an electoral victory these days because the 27%'s echo chamber is louder than ever. You are not going to reach out to True Believers in True Conservatism by pretending that you're a moderate, really, honest, no socialist here! because they're just going to snort in disgust and vote for someone more conservative than you. What you need to remember is the cardinal rule of politics: people come out to vote if they think they are PERSONALLY AFFECTED. This could be laws, policies, taxes, etc. that hit them or their families in the wallet; this could be civil rights issues involving them or their families or close friends; this could be moral outrage that SOMEONE out there SOMEWHERE is having an UNAUTHORIZED ORGASM or performing SOME ACTION that MAKES JESUS WEEP. But if you can't make an average person look at an election and think "hey, this affects ME," you're running for second place.

Which is precisely why running against someone who wants to end healthcare subsidies for a whole lot of average people and refusing to say plainly, loudly and repeatedly that the opponent wants to end healthcare subsidies for a whole lot of average people doesn't work. Nobody who thinks Glenn Beck is a prophet of the airwaves will ever vote your way unless you jar their worldview with the verbal power of a 12-gauge.
posted by delfin at 4:27 PM on November 15, 2015 [13 favorites]

There was a viable third option in this race.

Viable? That's debatable.
posted by SteveInMaine at 6:10 PM on November 15, 2015 [1 favorite]

ennui.bz posted:

Patricia Wanderlich got insurance through the Affordable Care Act this year, and with good reason: She suffered a brain hemorrhage in 2011, spending weeks in a hospital intensive care unit, and has a second, smaller aneurysm that needs monitoring.

But her new plan has a $6,000 annual deductible, meaning that Ms. Wanderlich, who works part time at a landscaping company outside Chicago, has to pay for most of her medical services up to that amount. She is skipping this year’s brain scan and hoping for the best.

I used healthcare.gov to check on plans for a 61 year old female, using a Chicago suburb as location, and trying different income levels until I found one that would trigger a subsidy ($20,000).

The least expensive premium was $15 per month (or $180 per year) for a $6,800 deductible and out of pocket maximum. Total potential spending for healthcare: $6,980.

The next plan on the list, from the same insurance company, was $84 per month (or $1,008 per year) for a $1,750 deductible and out of pocket maximum. Total potential spending for healthcare: $2,758.

I know the $69 per month can make a big difference in one's budget, and that spending 14% of your annual income for healthcare shouldn't have to happen, but when one has a known condition that can be both catastrophic (and expensive to monitor), I think comparing that to the possibility of spending 35% of your annual income in the event that second aneurysm becomes a problem makes that extra $69 justified.

I am not judging, as I am not in her shoes and cannot know what that $69 per month means for her, but she is taking a frightening risk that has a possibility of causing both a medical and financial disaster.
posted by 1367 at 6:24 PM on November 15, 2015 [2 favorites]

For a whole lot of people, there is no 69$/month. I mean, unless you want to turn off the electricity. I certainly know people that if they wanted to earn an extra 69$ a month, they'd have to resort to criminal activity (and not the victimless sort, like dealing drugs - that requires a capital investment)
posted by el io at 6:54 PM on November 15, 2015 [2 favorites]

You're being ableist if you say people need to get out and sign up voters because many people can't leave the house!

This is not actually a thing that "leftists" say.
posted by grouse at 7:05 PM on November 15, 2015 [5 favorites]

It seems like it would be their best hope for electoral success and yet year after year, I see establishment Democrats making almost no credible efforts toward increasing turnout and reaching those people who don't vote and aren't already politically engaged.

If I were a democratic candidate, I'd be wary of any plan to increase voter turnout in a population where those that do vote overwhelmingly vote Republican. I mean, why do you think the people who didn't make it to the polling station would've voted any different to those who did?
posted by Dysk at 1:23 AM on November 16, 2015

Only pawns in the game.
posted by carping demon at 2:05 AM on November 16, 2015 [1 favorite]

I mean, I have a master's degree and I can't fucking figure out medical billing. It's a trainwreck.
posted by desjardins at 6:02 PM on November 15

There is no such thing as medical billing. It's all smoke and mirrors and negotiations.
posted by roomthreeseventeen at 6:03 PM on November 15


Absolutely! To be precise Medical Billing in the US is a fig leaf disguising the fact that your bill is an initial negotiating position rather than an actual bill. At the end of last year I got angry at ridiculous hospital bills and dug a little deeper to discover how the absurd billing system works. Hospitals expect to receive from Medicare approximately a quarter of what they bill. And that's still somewhere round twice what you'd pay in the UK.

(Self-links)
posted by Francis at 5:22 AM on November 16, 2015 [6 favorites]

As someone who grew up in a poor rural town in Indiana (and, actually, in rural Kentucky as well, but my family moved away when I was young), I agree that identity politics are a huge part of this.

People identify as born again Christian, or they identify as military families, or they identify as Jeff Foxworthy rednecks/country folks. And those groups typically vote Republican, so they do too. It's not really about the individual issues, it's about who feels right. (Which is how I think an overwhelming majority of people on the left vote as well, for the record.)
posted by geegollygosh at 5:26 AM on November 16, 2015 [6 favorites]

There was a viable third option in this race.

Drew Curtis was about as far from viable as you can imagine, a political neophyte running a vanity campaign who's only discernible position seemed to be variations of 'a pox on both your houses'. Name the last major statewide candidate with his wife as his running mate. I'll wait.

About the only thing that can be said for Curtis is he probably pulled equally from both sides, so let's not blame him for Bevin, but to call his campaign "viable" is a complete joke.
posted by T.D. Strange at 4:15 PM on November 16, 2015 [2 favorites]

People identify as born again Christian, or they identify as military families, or they identify as Jeff Foxworthy rednecks/country folks.

And it doesn't help the left's chances of getting these votes when they openly mock all of these identities.
posted by el io at 1:09 AM on November 17, 2015 [1 favorite]

And it doesn't help the left's chances of getting these votes when they openly mock all of these identities.

It also doesn't sound like it's possible to make it any less likely...
posted by Dysk at 1:55 AM on November 17, 2015

Who Turned My Blue State Red? Why poor areas vote for politicians who want to slash the safety net. (Nov. 20, 2015)

In eastern Kentucky and other former Democratic bastions that have swung Republican in the past several decades, the people who most rely on the safety-net programs secured by Democrats are, by and large, not voting against their own interests by electing Republicans. Rather, they are not voting, period. They have, as voting data, surveys and my own reporting suggest, become profoundly disconnected from the political process.

The people in these communities who are voting Republican in larger proportions are those who are a notch or two up the economic ladder — the sheriff’s deputy, the teacher, the highway worker, the motel clerk, the gas station owner and the coal miner. And their growing allegiance to the Republicans is, in part, a reaction against what they perceive, among those below them on the economic ladder, as a growing dependency on the safety net, the most visible manifestation of downward mobility in their declining towns.

posted by andoatnp at 5:41 AM on November 21, 2015 [5 favorites]

That is a really interesting article. I see this very strongly in how people I know talk about benefits:

Where opposition to the social safety net has long been fed by the specter of undeserving inner-city African-Americans — think of Ronald Reagan’s notorious “welfare queen” — in places like Pike County it’s fueled, more and more, by people’s resentment over rising dependency they see among their own neighbors, even their own families. “It’s Cousin Bobby — ‘he’s on Oxy and he’s on the draw and we’re paying for him,’ ” Mr. Cauley said. “If you need help, no one begrudges you taking the program — they’re good-hearted people. It’s when you’re able-bodied and making choices not to be able-bodied.” The political upshot is plain, Mr. Cauley added. “It’s not the people on the draw that’s voting against” the Democrats, he said. “It’s everyone else.”

posted by Dip Flash at 5:53 AM on November 21, 2015 [3 favorites]