After a chaotic and charged week, House republicans celebrated the passage of their Obamacare repeal bill. But there's the political debate over health care, and then there's the lived reality, in communities across the country. The gap between the two is extremely clear in Kentucky, which is both governed by staunchly anti-Obamacare politicians and has seen record numbers of people benefiting from the Affordable Care Act. Brooke talks with Mary Meehan, a health reporter for Ohio Valley ReSource and Eastern Kentucky University's WEKU.fm, about how to reconcile the apparent contradictions and what national coverage of the health care debate tends to miss.
BOB GARFIELD: From WNYC in New York, this is On the Media. I’m Bob Garfield.
BROOKE GLADSTONE: And I’m Brooke Gladstone. On Thursday, the House rejoiced.
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MALE CORRESPONDENT: And it is official, it passes, the Republicans’ health care, the repeal of Obamacare, the Republican plan. Keep in mind, this is step one. It now has to go to the Senate, where it faces an uncertain future.
BROOKE GLADSTONE: This, even before the Congressional Budget Office could determine the effects of the bill and before many House members even read it.
FEMALE CORRESPONDENT: Have you read the whole bill?
HOUSE MEMBER TOM GARRETT: Oh gosh, I don’t think any individual has read the whole bill but we – that’s what – that’s why we have staff.
BROOKE GLADSTONE: The momentary triumph capped a week of missteps, sidesteps, falsehoods and impassioned critiques of the bill, many centering on the extent to which it protects people with pre-existing conditions, a key Obamacare provision. On Face the Nation, President Trump - wasn’t sure.
PRESIDENT DONALD TRUMP: Pre-existing conditions are in the bill. And I - mandate it, I said, it has to be.
JOHN DICKERSON: But on that question, that crucial question, it's not going to be left up to the states. Everybody gets pre-existing, no matter where they live, guaranteed.
PRESIDENT TRUMP: No, but the states are also going to have a lot to do with it because we ultimately want to get it back down to the states.
JOHN DICKERSON: It’s a guarantee?
PRESIDENT TRUMP: Look, ‘cause if you hurt your knee, honestly, I'd rather have the federal government focused on North Korea, focused on other things than your knee, okay?
BROOKE GLADSTONE: Meanwhile.
[JIMMY KIMMEL LIVE CLIP]:
JIMMY KIMMEL: You know, before 2014, if you were born with congenital heart disease, like my son was, there was a good chance that you’d never be able to get health insurance because you had a pre-existing condition.
BROOKE GLADSTONE: Jimmy Kimmel’s monologue about his newborn son's heart condition threw the political posturing into sharp relief.
JIMMY KIMMEL: If your baby is going to die and it doesn’t have to, it, it shouldn’t matter how much money you make!
BROOKE GLADSTONE: The gap between health care as a political football and health care as a lived reality is exceedingly clear in Kentucky. Its top lawmakers, among them Mitch McConnell, Rand Paul and Governor Matt Bevin, are staunchly anti-Obamacare. In all but two of the states, 120 counties went for Trump. And yet, the state has also seen record numbers of people insured under the Affordable Care Act.
Mary Meehan reports on health for Ohio Valley ReSource, a regional journalism collaborative covering Kentucky, Ohio and West Virginia.
MARY MEEHAN: I think, in part, Kentucky has become sort of a symbol because it’s coal country and then it’s also known as having poor health outcomes; we have high rates of obesity and diabetes and cancer. At the same time, they did a really good job of signing up people for health care. In some counties, it was 75, 90% of people who were uninsured got insured. So it does look a little - schizophrenic. [LAUGHS]
BROOKE GLADSTONE: So Kentucky is an Obamacare success story. Some half-million people got health insurance through the Medicaid expansion, but it wasn't rolled out as Obamacare.
MARY MEEHAN: It was called Kynect, K-Y-N-E-C-T, and the people who helped you sign up for Obamacare were called kynectors. And from the very beginning, the people in state government who were working to enroll people in Medicaid and Medicaid expansion or to get them to use the exchange never uttered the word “Obamacare.” Occasionally, they talked about the Affordable Care Act but there were television commercials about Kynect, there were billboards about Kynect, there were shopping bags with “Kynect” on them.
BROOKE GLADSTONE: The former governor, Steve Beshear, who led the effort for Kynect, said, quote, “We wanted to get as far away from the word ‘Obamacare’ as we could.” Do you think, if people had associated Kynect with Obamacare, they wouldn't have signed up?
MARY MEEHAN: No.
BROOKE GLADSTONE: They would have anyway.
MARY MEEHAN: Yeah, because I think the places where Kynect has had the greatest impact, there were people from those communities recruiting people within their community to get health care.
BROOKE GLADSTONE: Mm-hmm.
MARY MEEHAN: So they were the face of Kynect, and I think that matters. I think it was a pragmatic decision on the governor’s part to distance himself from Obamacare. The word “Obama,” during the political campaigns, it was a pretty toxic phrase here.
BROOKE GLADSTONE: Because Kentucky is both a Trump stronghold and a place where Obamacare has been so successful, from the outside it's easy to see it as a place where people are voting against their own interests, something that we liberal elites often say about people who [LAUGHS] voted for Trump. Do you buy that?
MARY MEEHAN: The Kentuckians who sort of took this step to create a very effective, very well organized, very well promoted Kynect program that enrolled hundreds of thousands of people in insurance are the same Kentucky voters who may have voted for Trump.
BROOKE GLADSTONE: Mm-hmm.
MARY MEEHAN: But it's more complicated than the single issue. I think the fact that you acknowledge the liberal elite view, that does have an effect on people when the message they're getting is that not only are their political opinions wrong but they are also perhaps not intellectually sound. [LAUGHS] I - I'm from Kentucky. I’ve have lived here about half my life. I’ve lived in a couple of other states, both south of the Mason Dixon line, but I recently was a Lemann fellow at Harvard and I was really shocked at the disconnect between the people that I know in Kentucky and the strongly-held assumptions about who those people are, that they were backwards and perhaps not very bright and if you were well spoken and didn't have a thick accent that you were somehow the exception.
BROOKE GLADSTONE: They made you an exception?
MARY MEEHAN: It felt like that to me sometimes, yes.
BROOKE GLADSTONE: Mm-hmm.
MARY MEEHAN: You know, I was thinking about this and I had a, a long drive to the office today and I was thinking about the questions that are asked. Is the question to ask, you voted for Trump and you got Medicaid, do you regret that now? Or, why did you make that that decision when you have benefited from this program? I think the better question to ask now that we’re trying to move forward and there is greater interest in flyover country, which I'm grateful for, is, what story hasn't been told?
BROOKE GLADSTONE: What is the story the media haven't told?
MARY MEEHAN: I think the reflection of Kentucky across the nation is really shown mostly through poverty porn, where they jet in to the poorest parts of the poorest place and they show the people in, in the most desperate situations. And, sadly, that is true for Kentucky, but there are also people within those same communities who are working very hard to maintain those communities, to grow those communities, to care for other people within that community, and I don't think that story is told enough.
BROOKE GLADSTONE: And do you think that if that story were told it would offer clarity in the, in the current debate over the Affordable Care Act and its repeal?
MARY MEEHAN: The focus is mainly on the cost and that, in the long term, the system is going to bankrupt health care overall, so by helping those who previously were uninsured, the story is that we’re threatening the entire system for those working-class or middle-class people who are more worthy of getting health care. You know, the representative who said people without pre-existing conditions lead good lives and, therefore, shouldn't have to pay for people who don't lead good lives. That reduces the status of one's health to your ability to work hard enough to maintain it. I have asthma. I've worked since I was 16 years old. Does the fact that I have asthma make me less worthy to have health insurance, if I lost my job? I think it’s a moral question.
So you have given people, a large number of people, medicine and access to care that could be either life changing or life saving and now you’re coming back around and you're saying, n - no, not really, we didn’t mean it. And why isn’t that a question of morality and not a fiscal responsibility?
BROOKE GLADSTONE: You mentioned that perhaps some Trump voters didn't actually think he would repeal Obamacare but that he’d make it better. What about now? Is the congressional chaos eroding that belief?
MARY MEEHAN: I think the congressional chaos is largely invisible to a lot of middle-class working folks who are trying to get through the end of their week. They’re not that engaged in the political increments of policy and so, unfortunately, I think it takes until the people get slapped in the face with the reality to prompt action, and that’s happened in Kentucky, where the town halls have been filled with people who are angry about the possibility of losing their health care. And there are a lot of activists in Kentucky who are also actively working to help motivate people to tell their leadership that they want to keep their health care.
BROOKE GLADSTONE: Given that you don't live in this bubble, what do you wish Kentuckians could hear from the media and from Washington and what do you wish Kentuckians could say to the media and Washington?
MARY MEEHAN: I think it's two-pronged. One, yes, fundamentally, there are people who live here who’ve been suffering for generations. Two, there are highly-qualified, competent people who have been successful in their education and their lives who also live here and who also may have voted for Trump. And I think that's the total message that has been lost. It’s not just ignorant rednecks who voted for Trump. There are people who I know to be very intelligent, pillars of the community who voted for Trump. So there's not “a Trump voter.” This disconnect between the media elite who were sure that Hillary was going to win and the people here that I knew who were sure that she was going to lose has to be sort of a jumping-off point. We have to look at how that’s happened, and I don't think it’s happened over the course of this election. I think it's happened over a long number of years.
I saw a recent map of where journalists are. There’s huge parts of the country where there's not very many, so let's see about getting out here. Have some people move here to cover Kentucky or, you know, look for people on the ground who are familiar with their communities and have a history of reporting them. That's how things will change. It’s not going to change by sending an occasional reporter to Whitley County to say, Trump voter, do you now wish you hadn't voted for Donald Trump?
[LAUGHS] I don't think that's the right approach.
BROOKE GLADSTONE: Mary, thank you very much,
MARY MEEHAN: [LAUGHS] You’re welcome.
BROOKE GLADSTONE: Mary [LAUGHS], what are you laughing about? [LAUGHING]
MARY MEEHAN: I did – did I defend my people adequately, that's what I'm wondering? [LAUGHS]
BROOKE GLADSTONE: I think so. I wasn’t attacking them.
MARY MEEHAN: No, I don't think you were. I just think it's hard to articulate because, on the face, it seems so incongruent. But I think that's why it matters to have some depth and knowledge of the place that you’re trying to report on because a lot of red states have not been on the media’s agenda for quite some time.
BROOKE GLADSTONE: Yep!
MARY MEEHAN: I mean, that’s the thing: Yes, there were Trump rallies but there were also large, large protests There was a, a women's march in Lexington, Kentucky that I have never seen a crowd that big, and there were places like Pikeville and Morehead and Bowling Green who also had anti-Trump rallies. So there’s not just one kind of Kentucky and that people are used to sort checkin’ a box about. There's a lot of different kinds of us. Come meet us. [LAUGHS]
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BROOKE GLADSTONE: Mary Meehan reports on health for Ohio Valley ReSource, a regional journalism collaborative covering Kentucky, Ohio and West Virginia. She's based at WEKU at Eastern Kentucky University in Richmond.
BOB GARFIELD: Coming up, the health care vote didn’t come from nowhere.
BROOKE GLADSTONE: This is On the Media.