Obamacare Showdown Over a Ham Breakfast in Kentucky

Jill Lawrence

LOUISVILLE, Ky.—The excitement at the Kentucky Farm Bureau Country Ham Breakfast is usually over how high the bids will go when a ham is auctioned. But this year, it came when Democratic Gov. Steve Beshear made an emotional case for the Affordable Care Act as a chance to change his state's long history of poor health.

It was not what anyone expected—least of all Republican Sens. Mitch McConnell and Rand Paul, who sat stone-faced onstage with Beshear as he unloaded on them without using names.

Thus did the 50th annual ham breakfast at the state fair become a showcase for national divisions and passions, with some 1,600 diners as witnesses.

The mayor of Louisville, Democrat Greg Fischer, set a light mood with a brag-fest about his city's food and restaurant scene and the nearby farmers who have helped make Louisville "the national leader" in the local food movement, "on all the right lists" from Zagat to Southern Living.

But within moments the breakfast crowd found themselves watching a heated Obamacare debate—the kind that normally goes on in Washington, not at Kentucky agricultural events.

Beshear was the homespun populist, appealing to people's instincts to want the best for their friends, relatives, and neighbors. The senators, surprised by the full-bore politics, struck back at the expense of the health law and its impact on business. Those were familiar arguments made by the many vocal opponents of the law, strengthened this week here by UPS's announcement that it was eliminating coverage for spouses who could be expected to get or buy coverage Jan. 1 under ACA.

Beshear's advocacy, by contrast, was striking in its intensity and in how personally he approached the issue, picking up on the idea that many people who don't have health insurance are embarrassed by that and don't talk about it.

The governor compared health insurance to "the safety net of crop insurance" and said farmers need both. He said 640,000 Kentuckians—15 percent of the state—don't have health insurance and "trust me, you know many of those 640,000 people. You're friends with them. You're probably related to them. Some may be your sons and daughters. You go to church with them. Shop with them. Help them harvest their fields. Sit in the stands with them as you watch your kids play football or basketball or ride a horse in competition. Heck, you may even be one of them."

Beshear went on to say that "it's no fun" hoping and praying you don't get sick, or choosing whether to pay for food or medicine. He also said Kentucky is at or near the top of the charts on bad-health indicators, including heart disease, diabetes, cancer deaths, and preventable hospitalizations. He said all that affects everything from productivity and school attendance to health costs and the state's image.

"We've ranked that bad for a long, long time," he said. "The Affordable Care Act is our historic opportunity to address this weakness and to change the course of the future of the commonwealth. We're going to make insurance available for the very first time in our history to every single citizen of the commonwealth of Kentucky."

About half the audience burst into applause at that point while the other half sat on their hands. But he wasn't done. He cited a study that showed the law would inject about $15.6 billion into the Kentucky economy over eight years, create 17,000 new jobs, and generate $802 million for the state budget.

"It's amazing to me how people who are pouring time and money and energy into trying to repeal the Affordable Care Act sure haven't put that kind of energy into trying to improve the health of Kentuckians. And think of the decades that they have had to make some kind of difference," Beshear finished pointedly.

McConnell—first elected in 1984—smiled. Then it was his turn. He approvingly quoted Teamsters Union president Jimmy Hoffa as saying Obamacare was destroying the 40-hour work week and expensive union-negotiated health insurance plans, and squarely blamed Obamacare for the move by UPS, the biggest employer in Kentucky.

"So, governor, the solution to Obamacare is to pull it out root and branch," the Senate minority leader said to cheers.

Paul, who wants to try to defund the law as a way to buy leverage to delay it and ultimately kill it, picked up on Beshear's point about the economic benefits. "It's going to bring $15 billion to our state. From where?" he asked, his voice rising. "From the Federal Reserve, which is already sitting at minus $17 trillion. It's not free. There are consequences to this."

Later, Paul told National Journal Daily that he was surprised by Beshear's speech. "The farm breakfast is usually a little less partisan, and I had not planned to say anything about Obamacare," he said. "This is more about farmers and issues directed toward farmers. I typically don't talk about more partisan issues before a less partisan crowd. I usually take the opportunity to talk about things that people tend to agree more on—two or three issues where I work with Democrats." On Thursday, those issues included civil liberties and pulling back aid to Egypt.

Kentucky is a complicated political state—conservative, with two Republican senators and negative views of President Obama, but Democrats still have a voter-registration edge over Republicans (1.7 million last month versus 1.2 million for the GOP) and they have elected a Democratic governor, lieutenant governor, attorney general, and secretary of state. In addition, Kentucky is unusual in that the governor had the authority to create a health insurance marketplace and expand Medicaid under the Affordable Care Act without having to go through the Legislature.

The ham breakfast made sense as a venue to discuss those decisions. "We know farmers would be a group that would stand to benefit from the Affordable Care Act," said Beshear's spokeswoman, Kerri Richardson. "That was the reasoning for the topic he chose."

Beshear has made clear he is a man on a mission, to make history by making a success of the Affordable Care Act in a red, Obama-resistant state. It's unlikely McConnell and Paul will be caught off-guard again.