Kentucky Governor Steven Beshear

Mark Masselli : This is Conversations on Health Care . I'm Mark Masselli .

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli : Well Margaret , I'm trying to get my head around the appropriate word to
describe the roller coaster ride we’ve been on since the launch of the online Insurance
marketplace , e special ly the federal exchange , but I seem to have brain f reeze .

Margaret Flinter: Well there are a lot of words I can think of but let’s go with tumultuous ,
that would seem appropriate . The actual number of folks who ha ve managed to sign up
on the Federal Exchange as of last week certainly h a s com e in lower than estimates in
the media. Only about 27,000 have been able to sig n up for coverage on the
www.heal thcare.gov website so far.
Mark Masselli : It would be an understa tement to say that that’s far lower than the
Obama Administration hope d for number of half a million, which was the target for the
first six weeks of the operation on the online marketplac e . Hopefully, it's going to
improve.
Margaret Flinter: And we do have to remember to combine the federal numbers with numbers from the state - base d exchanges which I think are going more smoothly th a n
we get a number of about 120,000. Now Mark , we shoul d no te that those numbers are
expected to increase much more rapidly as we get closer to December 15

th
which is the
st
deadline to enroll for coverage and be covered by the 1 of January . So that’s an
important next chunk of time.
Mark Masselli : It certai nly is , and folks are simply going to have to be patient w ith the
federal exchange w h ere a team of expert s, probably an army of expert s a t this point
continue to recalibrate the website and hopefully fix the issues that are out there so it
can handle the i nflux of so many customers using the site at once . So far , the
administration is sticking to its promise by the end of November as the target for getting th e s e problems work ed out.
Margaret Flinter: And Mark , of course , we’ve seen so much focus now on t he President
responding to a very contentious area , the fact that millions of Americans were
experiencing their in surance plan , that they may have liked , being canceled because
they didn’t comply with the Health Care Law’s Essential Benefits C l ause .

Mark Masselli : There was quite a r uckus politically over th ose cancelation s so the
President decided , certainly after the prompt ing of former President Bill Clinton to offer a
provision for those who want to keep their plan for one more year and they are going to
be able to do so. Meanwhile , I think when people really look at what kind of coverage
they are getting o n those old plans versus what they will get by purchasing health
insurance on the exchanges , the y will likely find a more beneficial plan o n the
ex change.

Margaret Flinter: Well the American consumer is definitely having to do a deep dive into
understanding insurance plans more than they ever have before and that’s just going to
take some time for consumers across the country to understand what ’s i n it for them ,
what doe s it all mean . And that is really hard to do right now with all the political noise
and the media attention , the opposition and the difficult technical roll out .

Mark Masselli : There is a light at the end of tunnel for those who ha ve been concern ed
about other states out there running good plans , and our guest today can offer an
entirely different perspective on the health care law. Kentucky Governor Steven
Beshear is overseeing a very successful roll out of his state ’s insurance ex change.

Margaret Flinter: And the governor will provide some really tremendous insight into how
the Affordable Care Act is poised to make a real difference in the health of a state, the
health of its people and the health of its economy w hen the system i s working as it
should and firing on all cylinders .

Mark Masselli : Lori Robertson , Managing Editor of FactCh eck . org will be stopping b y to
s hine a spotlight on misstatements about health policies spoken in the public d omain .

Margaret Flinter: And no ma tter what the topic , you can hear all of our shows by
Googling CHC Radio.

Mark Masselli : And as always , if you have comments, please contact us at
www.chcradio.com , or find us on Facebook or Twitter; we love to he ar from you.
Margaret Flinter: We wi ll get to our interview with Kentucky Governor Steven Beshear
in just a moment.
Mark Masselli : But first here is our producer Mar ianne O’Hare with this week’s Headline
News .
(Music) Marianne O’Hare : I'm Marianne O ’Hare with these Health C are Headlines. 3% a n d
counting , that’s the percentage of hope for 7 million Americans who’ve been able so far
to sign up for health cover age on the Federal Health Exchange

www.healthcare.g ov .
The Obama Administration had been jonesing for half a million by now . The problems
st
that have plague d this site since it launch ed October 1 continue to confound co d ers
and designers who’ve been handpick ed by the White House to fix their health care
website that serves 36 state s across the nation . The problems still center on the data
hub through which all applicants must be processed to link to their t ax information . The
administration is still targeting the end of November as the i r self - impose de adline to fix
the issues. What these problems elucidate is really a fight for credibility for the Obama
Administration . Throughout President Barack Obama’s first four years , he prided
himself on his ability to bounce back when Washington thought his Pres idency was i n

peril . This time the President is fighting to regain trust and credibility with the American
people and some within his own base who are defecting over the Health Care Law .

On the other hand , the Medicaid exp ansion seems to pai nt a differen t picture across the
st
country . 450,000 Americans have signed up for Medicaid since October 1 , especially
in those states where the Medicaid expansion was initiated . About half the states in the
nation have expanded Medicaid to include folks making 136% of poverty , although
problems with the website are pl aguing their experience as well. Meanwhile , mental
health and substan ce abuse coverage are closer to being a sure bet under the
Affordable Care Act . The administration just released final rules on cove rage for mental
st
health issues that will be part of the norm come January 1 . These request s are to be
treated in a similar fashion as any other heath cl aim .

Meanwhile , there is more fallout from the millions of insured Americans whose policies
are being canceled by their car ri ers. The President had promised anyone who wanted
to keep their insurance w ould be able to but millions of policies are being dropped
primarily because they don’t contain the 10 essential benefits required by the Health
Care Law. The State of California has extended cancel ed policies for 100,000 residen ts
there until a workable solution can be found.

And want to keep your brain healthier longer ? Brain games and quiz shows alone won’t
do it, unless you are running in place while w atching Jeopardy . Studies conclusively
show that sweat equity is the great brain prophylactic exercise in a number of studies
recently , has been prove n to be the most reliable brain preserving activity , regular
exercise overtime that leads to sweat and ae robic increase so off the c ouch with you
now.

I'm Marianne O’Hare with these Health Care Headlines .

(Music)

Mark Masselli : We a re speaking today with Kentucky Governor Steven Beshear , a
Democrat, now in his second term. Governor Beshear is a n attorney who serve d in the
Kentucky House of Representatives , also served as the state ’ s attorney general . He
was the Lieutenant Governor under Governor Collins and i s the past chairman of the
Southern Governors Association . Governor Beshear , welcome to Conversa tions on
Health Care

Governor Steven Beshear: Thank you Mark.

Mark Masselli : You have been getting quite a bit of attention since you launched
st
Kentucky’s insurance exchange October 1 and you’re the only governor of a southern
state who chose to both setup a state - base d exchange as well as expand Medicaid, and
you had to do it by executive order , overri d ing political opposition with in your own state.
W hile the Federal Exchange has been plagued with problems that have only served to
fuel the partisan debate over the Health Care Law , Kentucky ’ s exchange c alled Kynect

is being held up as a national model for success. So you’ve seen thousands of
residen ts who have been signing up daily and can you give us a sen s e of how it's going
and is it me eting your expectations ?

Governor Steven Beshear: Well Mark , we a re very proud of what Kentucky has done
with its health benefits exchange . We just had resounding success far beyond our
wild est dreams quite honestly . We work ed hard and I think we did the right th ing s and
when we kick ed it off on October 1 at 12:01 a.m., little did we know that so far , we were
going to have over 400,000 visitors to this website . I mean Kentuckians have been
swarming this website . We’ve had over 100,000 calls on our toll free hotl ine into our
call center. People are hungry and eager to get the information about health care . We
have now enrolled over 40,000 , almost 41,000 people in new affordable health
coverage .

I think an interesting statistic is that in addition to individuals , 843 small business es have
started application for employee coverage. And I think that’s important because as you
know , a lot of misinformation is being thrown around by the critics of the Affordable Care
Act and one of them is oh it’s going to destroy b usiness and lose jobs and all of these .
Well we a re finding that our small businesses are re ally getting the information and
going after this because they find that it is a help . I think another interesting statistic is
that 41% of our total enroll ees so far are under the age of 35 and that also was one of
those bugaboos that the cr itics tossed around oh you’re not going to get the young
people to sign up and therefore it's not going to work. Well it is working in Kentucky and
we ’ re excited about it.

Ma rgaret Flinter: Well governor, it w ould certainly seem clear that a lot of things were
done right including public education and communication and PR . And as we look at
this , and I understand that the same company that created the federal exchange , CGI
w as actually one of the contractors on your sta t e ’s si d e as well and obviously it sounds
like you’ve ha d very different experiences . For the purpose of how we learn , what do
you think some of the critical differences might have been between the design of t he
Kentucky exchange versus the federal exchange ; what made it work so well?

Governor Steven Beshear: I think part of our success is the fact that early on when we
got ve nd o rs in , we surrounded those vendors by our Medicaid people, our public health
peop le , the folks that work ed with th e s e programs everyday and they work ed hand - in -
hand 24 hours a days seven days a week to design this website . They design ed a
simple straightforward website , we didn’t have any real bells and whistle s on it and we
tested it thoroughly . We had the federal government in several times to test it for us
and we work ed those kin k s out ahead of time so that when we kick ed it off , we were
able to hit the ground running and we had very few issues and problems. I think one of
the ke y decisions we made that has made a big difference is the fact that we decided to
allow anybody and everybody who wanted to , to go on that website and browse and get
all of the information they wanted. And then at whatever point those people were ready
to create an account , then they could go over and click on a button and that would take
them into that process. Quit e honestly , another reason that ours was successful is

we’re dealing with one state’s insurance laws whereas the federal exchange ended up
ha ving to deal with 36 different state insurance stat utes . And of course they are dealing
with 40 or 50 million people ; I'm dealing with about 650,000 . But I do think that that
decision about opening an account and when you had to do that was critical to o ur
success.

Mark Masselli : Well I think it wa s brilliant because we are a country of browsers and we
like to shop around , kick the tires on things and check it out. You’ve got te n quite a bit of
attention from your recent Op - Ed p i ece you wrote in New Yor k Times and it was a great
one. And you admonished detractors trying to derail the Affordable Care Act simply for
political reasons , and it really struck a c h o r d with us . We’ve been in the tr enches,
providing services to the under served population for de cades , and like you , we see this
benefit of populations having access to affordable health coverage . And you sa y
though th at health care l aw makes sense not only from a population heath stand point
but from a moral one as well and you went even so far in y our Op - Ed piece to tell the
opponents of the health care to get over it. So t ell us a little bit about the reaction and
from that point on reflection , any other thoughts that you might have for our listeners.

Governor Steven Beshear: When I look at Kent ucky , our health statistics are awful, and
that didn’t just happen yesterday. I mean they have been awful ever since they started
keeping statistics . And I knew that to really make a transformational change , we had to
have some kind of transformational t oo l; we couldn’t do it just by interest. We had to
really tackle this thing and to really make huge changes . The Affordable Care Act gave
me that opportunity and we seize d on that opportunity. We have got 640,000
Kentuckians that don’t have any affordab le health coverage , and obviously , from a
moral standpoint , if I could do something that would finally get those folks for the first
time in Kentucky’s history to have affordable health coverage and to be able to say for
the first time in our history that every single Kentuckian now has access to affordable
health coverage , then it was something I was going to do and that’s the mission we a re
on.

You know, when I hear the critics complaining about this , what I want to say to them is
look , those 640,000 peo ple in Kentucky , they are not some group of aliens from a
foreign planet or something ; these are our friends and our neighbors . These are people
we go to church with, we shop in the grocer y with them , we go to the football and
basketball games , sit in the bleachers on Friday night and watch our kids play ball and
these are people that will make a huge difference in our state . There are people that
get up everyday and roll the dice hoping and praying they don’t get sick . They know
that they are one b a d di agnosis away from bankruptcy. And think of living with that 24
hours a day, seven days a week when you’re trying to raise your family and give them
the quality of life that they deserve. If we can remove that burden and we can provide
affordable health c overage for ever y body in this state , what a great state we a re going
to have in the next generation.

Mark Masselli : Amen.

Margaret Flinter: Well governor , I don’t know that anybody ha s said it better yet, so
thank you for saying it so eloquently . And you know, you just spoke really to the
economics of the situation as well I know you have said that expanding coverage to
over 600,000 uninsured residen ts in Kentucky will have most of all economic benefits .
And I understand that you had Price Waterhouse and other analysts do a
comprehensive audit to try and really sort of nail down what is the potential economic
impact of taking th e s e actions of expanding Medicaid , setting up the exchange . Tell us
about the results of these findings and why you think so many other states didn’t come
to the same conclusion .

Governor Steven Beshear: Well , first of all , I think it will happen . I think that down the
road , the people of those states are going to grab their politicians to make the right
decision. It was an easy decision from one standpoint . It is the morally right thing to do
but as a governor , I have got another part of that decision to make and that is, is it
physically responsible for me to make this decision because if I make this decision and
it puts u s in the bankruptcy or puts us into a bad situation economically , then I’ve done a
dis service long term to my state also. So before I made the decision , I ask ed
Pricewaterhouse Coopers and the Urban Institute over at UoL , I said do an economic
analysis of this for me. They came back after about six months , look ed me in the eye
and said , governor , you cannot afford not to do this . It will infuse about $ 15 billion into
your economy over the next eight years ; you’re going to create about 17,000 new jobs
ove r the next eight years.

When I look at other states that aren’t doing this , unfortunately I see politics standing in
the way and my message to them would be the same message I'm giving to Kentucky .
And so I sa y , look , you don’t have to like the President , you don’t have to like me
because this is not about the President and it's not about me, it's about you, it's about
your family, it's about your kids , so do me a favor , it's not going to cost you a d ime to go
on that website , call that telephone number o r s i t down with a connector and find out
what’s available for you and I'll guarantee you when you do that , you’re going to like
what you f i nd. I’ve got 4.3 million people to take care of and t o try to improve their
quality of life and here is a n historic opportunity that every state has to do exactly th at
and every state is going to be doing this because the people of that state are going to
put the pressure on and force political leadership to step up.

Mark Masselli : We a re speaking today with Kentucky Governor Steven Beshear , a
Democrat now in his second term . Governor Beshear is a n attorney who serve d in the
Kentucky House of Representatives . Governor, speaking of politics , you are the only
governor of a southern state expanding Medicaid in setting u p an exchange but you
also have two of the most vociferous opponents of Obamacare representing Kentucky
in Congress, Senators Mitch McConnell and Rand Paul , both who have been actively
involved in the rece nt government shutdown in an attempt to thwart the health care law.
You recently said that the states are really where the rubber meets the road. What sort
of impact has t he shut down , the f arm bill not be ing passed in the sequester cuts had on
the health of your state?

Governor Steven Beshear: Well Ma rk, first of all , I like to say that Kentucky is one of
the few places in the country where democracy apparently still works. Obviously our
camp aigns are like all campaigns. They’re rough - and - tumble and we go at it. And so
we do something unusual ; we ac t like adults . That’s really the bottom line here is --

Mark Masselli : You’ve got to bring that to Washington.

Governor Steven Beshear: If Washington wou ld just look at h ow we are all looking at
them , I mean the people of Kentucky are disgust ed with wh at’s going on in Washington ,
Republic and the Democrat alike . And it is time to quit acting like a bunch of spoil ed
children. We don’t agree on everything but we also know that to move the state f orward
we have got to work together . The shutdown was cra zy and we all know that. I think
the only people who don’t know it are the ones that are still in Washington DC ; the rest
of the country knows how nutty that was n ot having a farm bill and how many more
years are we going to go without a farm bill . Agric ulture is a huge part of our economy .
These sequester cuts , all th e s e across the board kind of thing , doesn’t make any sense.
Yes , we need to get our budget in balance . In Kentucky , we have to have a balance d
budget and so for the last five years , I hav e balance d and rebalance d our budget during
this worst recession of our lifetime about 12 times now. I’ve cut $ 1.6 billion out of
spending in our state, which for a small state is a lot of money. But we did it in a smart
way . We set our priorities . We set education as the most important thing we do here in
Kentucky and where our money ought to be invested . So we prior itized our budget
balancing , and because of that , we a re coming out of this recession I think a lot better
of f and a lot faster than lot of other states are.

Margaret Flinter: Well governor , there is another area of transformation we a re curious
about relative to what Kentucky is accomplishing and that’s in the area of biotechnology
which obviously is poised to have a powerful impact on t he kind of health care that we
have in the future. Now I understand the publication Fast Company rank ed Kentucky
nd
2 in the nation in the number of startups created in the past few years and that many
of those were in the biotech area so clearly some robu st activity in your state. How
does this all tie together with the changes under the Affordable Care Act ?

Governor Steven Beshear: Well we are very proud of what we’re doing economically
here . As I mention ed, we a re coming out of this recession I think a lot faster than a lot
nd
of other places . In addition to the facts that you mention ed about for being 2 in the
nd
nation in the number of startups created in the past few years , l ast year we were 2 in
job growth rate in the country also a nd we’ve had rec ord exports for last year and now
we’re going to exceed that for this year . So part of that Margaret is you have to have an
educated workforce . And so we’ve made a priority of education reform in Kentucky and
I'm happy to say that in that area also we a r e setting the mark of excellence across this
country. We were the first state to adopt the Common Core Academic Standards . We
are the second state to adopt the Next Generation National Science Standards. We just
raised our dropout age from 16 to 18 here in Kentucky . So we a re really on the move in
educating our people . And that all comes down to what’s going to happen in the future
here because as much as companies that we talk and try to attract to Kentucky want tax

incentives and infrastructure and r oads and all of these things , their priority , 99 out of
100 CEOs tell me that their biggest priority is an educated workforce ; I’ve got to have an
educated workforce .

And so that’s what we’re working on . And you know what , if you have got an educated
wor kforce but they are homesick all the time, or they are home with their kids because
they are sick and they can't take them to the doctor , if they don’t get the prevention and
wellness benefits out of affordable health coverage , then they’re not a productiv e
workforce. You r business folks , the smart ones , and that’s most of them, know that the
bottom line is a productive workforce and they know that you can't have that unless you
have a healthy workforce . So it ’ s been exciting to see what I think we a re go ing to do
because of the Affordable Care Act in developing that healthier workforce which is just
going to help us to attract more bio tech f i rms , it’s going to help us to attract f i rms of
every kind and character because we’re going to have th e kind of wor kforce they are
looking for.

Mark Masselli : Governor , another emerging area in health innovation is really in the
health information technology area . We’ve seen a huge push in promoting the
expansion of health IT . We have had many folks on from around the country talking
about the investments they’ve made under the HITECH Act and w hile we still have a
long way to go , you have made it clear the Affordable Care Act is going to have a huge
impact and you’ve talk ed about that today very eloquently on the ov erall health ranking
for your state by improving access . But what role does health IT play in your long term
goals for Kentucky and what vision do you have for a connected health IT system
l inking various health entities in your state ?

Governor Steven Be shear: It's going to play a very big role I think in the future of health
care in Kentucky . And we are being very aggressive in e H ealth initiatives . We create d
legislation to create an e H ealth network and at that time , only a handful of providers
were s toring health information electronically . But we’ve pushed the development of
that and hundreds of hospitals , p hysician practices , optometrists, labs, other medical
facilities are now members of what we call the Kentucky Health Information Exchange .
We c urrently have about 400 providers l ive on that health information exchange and
another 450 in the process of connecting or s ign to user agreement , establishing some
kind of formal relationship between the facility and the Commonwealth of Kentucky. So
we s ee the health information system and initiatives as an integral part of the future of
successful and affordable h ealth c are in the Commonwealth .

Margaret Flinter: We’ve been speaking today with Kentucky Governor Steven Beshear .
To learn more about the K entucky health exchange and how it's working , you can go to
kynect .k y .gov and you can learn more about the governor ’ s administration by going to
governor.ky.gov . Governor Beshear , thank you so much for joining us o n
Conversations on Health Care today.

Go vernor Steven Beshear: Mar k, Margaret , thank you all very much for having me.

Mark Masselli: At Conversations on Health Care, we want our audience to be truly in
the know when it comes to the facts about health care reform and policy. Lori
Robertson is an award - winning journalist and managing editor of FactCheck.org, a
nonpartisan, nonprofit consumer advocate for voters that aim to reduce the level of
deception in US politics. Lori, what have you got for us this week?

Lori Robertson : Well President O bama has faced criticism recently for promising if you
like your health care plan you can keep your health care plan . But we’ve been saying
for years that he can't make that promise to everyone. Reality is catching up to his
political spin. Several re ce nt news report s have focused on American s who purchase d
their own insurance on the individual market and who have receive d cancelation letters
for their plan s. The insurers say the plan s won't meet the Essential Benefits Standards
required by the Affordab le Care Act. That includes prescription drug coverage ,
maternity care, mental health benefit s and more. Th e s e individual market plans will
cover more but at higher premium s. About 1 5 million Americans or 5% of the
population b u y insurance on this market . Plans purchase d before the law was passed
could be grandfather ed in and therefore not subject to th e s e new requirement s but they
can't change significantly or they are no longer grandfather ed . We’ve said the President
can't make that promise to those w ith comprehensive employer - sponsor ed coverage
either. We first heard about Obama’s claim in August 2009 when the law was still being
debated. We cited an analysis by the nonpartisan Congressional Budget Office that
estimated 3 million people with employe r plans wouldn’t be offer ed coverage . Some
employers may sen d low wage workers on to the exchange s for insurance rather than
continu ing to provide it themselves. Trader Joe’s recently announced that’s what it
would do , sending part - time workers to the ex change s along with $ 500 to help them buy
coverage. And that’s my fact check for this week . I'm Lori Robertson , managing editor
of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact, that you would like checked, email us at
www.chcradio.com . We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Health Care.

(Music)

Margaret Flinter: Each week Conversations highlight s a bright idea about how to make
wellness a part of our communities and everyday lives. Right now , there are about 3.5
million peopl e living in refugee camps around the world . Whether displaced by wars or
natural disasters , the pl ight of th e s e people is often the same , living in squalid
conditions , in ten t cities th at provide little protection from h arsh elements a nd th e s e
conditions pose serious threa t s to their health and well - being . The IKEA Foundation
has taken the parent compan y’ s widely successful Do - It - Yourself approach to home
furnishings and applied it to the problem of inadequate housing for displaced refuges.
They’ve creat ed a do - it - yourself dwelling th at can be ship ped and assemble d anywhere.

Jonathan Spampinato : So first and fore most , there is the very well - know n flat - pack
approach that IKEA h as pioneer ed and secondly, the materials and the product itself .
So it's a sh elter , it's not a tent.

Margaret Flinter: Jonathan Spampinato is the Head of Communications and Strategic
Planning at the IKEA Foundation . They are working closely with United Nation s
o rganization s working on the ground , trying to assist refugees in Som alia and other
parts of the world.

Jonathan Spampinato: We extend ed that to also include funding for a n innovation unit
within the UNHCR so they could think more long term . So providing that funding
allowed them to start refugee housing shelter , looking at how to design a better shelter.

Margaret Flinter: And since o n average , a person is likely to spend up to 12 years in a
refugee camp, th e s e IKEA structures have some unique properties that can make the
experience more bearable.

Jonathan Spampinato: The wall s and the roofs are made out of a new fancy version of
basically a plastic material that is much more durable but very, very li ghtweight and still
is insulated .

Margaret Flinter: The IKEA Foundation currently has prototypes being tested in vario us
refugees camps and will scale up production once refinements are made. And true to
IKEA , the price point is going to com e in under $ 1000 per structure . A deliverable,
affordable do - it - yourself dwelling th at can provide some sense of dignity, privacy a nd
protection for families who a re struggling as refugees , n ow that’s a bright idea.

(Music)

Margaret Flinter: This is Conversations on Health Care . I'm Marg a ret Flinter.

Mark Masselli: And I'm Mark Masselli , p eace and Health.

Conversations on Healt h Care, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.