Medicaid ignored, but Medicare trips up Bevin

DANVILLE, Ky. - Both major candidates for governor don't like talking about the biggest issue that could have the greatest immediate impact on the most Kentuckians - the 400,000 who are getting free health care because the state expanded the federal-state Medicaid program under the federal health-reform law.

Republican Matt Bevin says he would scale back the expansion, but won't say how. He prefers to repeat the unsupported claim that the state can't afford the expansion once it starts having to pay a small part of the cost. Actually, there's a good case to be made that the expansion will pay for itself at least through the next two-year budget, by creating health care jobs and tax revenue.

Democrat Jack Conway, citing Bevin's February statement that he would immediately end the expansion, says his foe would kick all 400,000 off Medicaid. Conway takes a wait-and-see attitude toward the expansion's cost. However, it's not a topic he likes to raise; he doesn't like being accused of wanting to blow up the state budget with "Obamacare," already a topic of a Republican attack ad.

Despite the importance of the issue, in Tuesday night's debate at Centre College, WAVE-TV moderator Scott Reynolds didn't ask about it. He told me that he and the sponsors (including AARP) tried to avoid repeating questions from previous debates, but the omission was the opening point of some stories about the debate, which generated little news.

Conway did make Bevin generate news by asking him a question about Medicare, the health care program for seniors - which often gets confused with Medicaid, largely for the poor and disabled. Drawing on a statement Bevin made at an April 11Tea Party rally in Louisville, Conway asked, "Why do you support random drug testing for Medicare recipients?"

Bevin's answer made him more than ever like "The Pilgrim" of Kris Kristofferson's classic song, especially this line: "He's a walkin' contradiction, partly truth and partly fiction, takin' every wrong direction on his lonely way back home."

Bevin replied: "We need to hold people to account. If you're an able-bodied, working-age man or woman, there should be some expectation of you, if you have no dependents, no children..."

That sounded like Bevin's past statements on Medicaid, so Conway interjected, "We're talking about Medicare, Matt." Bevin replied, "Understood," and went on. But at the end of the exchange, he said, "We're talking about Medicaid in this instance, Jack, and you know that." But that's not what he said on April 11.

Courts have said there must be probable cause to test such people, but that sort of testing is not random testing. Yet Bevin spoke of them in the same breath. More significantly, his "on the draw" lines rightly drew protests from people in both parties, because Medicare is not welfare. (And neither is Medicaid.) People on Medicare pay premiums! In the exchange, Bevin continued his point: "...there should be expectation of you, as somebody who is a recipient, or, as it's often referred to in this state, on the draw. If in fact someone is on the draw, there should be, with constitutional understanding of how it's to be done - you can't just indiscriminately drug-test people - but you can in fact have probable cause, and I do believe we should have random drug testing for people who are on social benefits."

Bevin then gave us another glimpse of his attitude toward public assistance. After noting that military members and first responders are randomly drug-tested, he asked, "Why should people that are getting everything from those who are working every day and randomly drug tested have no expectation whatsoever on them of a similar front?"

People who are "getting everything"? Even if you're in public housing and get food stamps or other forms of public assistance, your "everything" is nowhere close to the "everything" most Kentuckians enjoy - and a far piece from the "everything" of multi-millionaire Matt Bevin. He seems to have disdain for, and a lack of understanding of, those "on the draw

To be sure, just about every government program has its abusers and chiselers. And it might be a good idea, as Bevin has vaguely suggested, to require the better-off beneficiaries of expanded Medicaid to have some "skin in the game" through premiums, co-payments or health savings accounts. But we need to know what his plans are. He's not telling, instead appealing to class prejudice. Such disrespect for voters is good reason for them to reject him.

Bevin may be a demagogue and ideologue on policy, but he's pretty good at politics. He's a better salesman for himself than Conway, and his latest TV ad is one of the best of the race, with a largely positive message that takes very brief slaps at Conway and President Obama.

"Outsider businessman Matt Bevin . . . Christian values, conservative leadership, a fresh start for Kentucky," the ad says. Meanwhile, Conway has doubled down on ads using the same hyped-up, largely discredited charges about Bevin that U.S. Sen. Mitch McConnell used in their primary fight last year.

In economic terms, Democratic attack ads have reached the point of diminishing returns, perhaps even the point of negative returns. As the recent Bluegrass Poll and my journalism students' interviews with poll respondents indicated, voters are tired of the attacks. They are likely to respond favorably to a positive message.

Tuesday night, I asked Conway consultant Mark Riddle if they think they can win the race by running only attack ads. He replied, "There's a lot of days left in the election, and we've got plenty of money." That suggests that Conway will spend part of his $2.3 million campaign account on more positive messages. That's overdue. But don't expect him to say much if anything about Medicaid.