In an interview with Kentucky Health News a few days before Christmas, Gov. Andy Beshear said he would be pleased if one of his legacies as governor was improving the health of Kentuckians, and looked forward to the upcoming legislative session.
Beshear acknowledged that if Kentucky has clearly improved its health status when his term ends in 2027, he would have to share that legacy with his father, Steve Beshear, who expanded Medicaid coverage in Kentucky to 600,000 people when he was governor from 2007 through 2015.
“I’d love for both Beshears to be remembered for that,” he said.
Beshear’s comments came after he was asked why he thought Kentucky showed a slight upward trend in the latest America’s Health Rankings by the United Health Foundation.
The foundation ranks Kentucky 41st for overall health, up from 43rd in the last two rankings (2022 and 2019; the rankings were not made in 2020 and 2021 due to the pandemic). The state was 45th in 2018, 42nd in 2017, 45th in 2016, 44th in 2015 and 47th in 2014.
Beshear said increasing access to health care has been key to improving the health of Kentuckians, not only as a way to improve the quality of their lives, but as a way to improve the state’s workforce.
“I believe that we are doing better, and that we will do better for a couple of reasons,” he said. “First, especially coming out of the pandemic, we are seeing expansion of health-care access all over Kentucky.”
As examples, he pointed to the first hospital being built in West Louisville in 150 years, the expansion of the Bullitt County hospital and the new clinic that Morehead-based St. Claire HealthCare is building in Morgan County. He said health-care systems are “recognizing that the overall health of our people is a shared responsibility.”
Other examples, “especially over the last four years,” he said, are “the leaps we have made in treating addiction, especially the number of treatment beds.”
He said Kentucky has the most treatment beds per person in the country, and that has improved the overall health of Kentuckians.
“That’s a big start towards getting people healthy,” he said.
Beshear agreed that his father’s 2014 expansion of Medicaid to people who earn up to 138 percent of the federal poverty level, under the 2010 Patient Protection and Affordable Care Act, has played a key role in improving access to care. He noted that his administration has extended post-birth Medicaid coverage from 60 days to 12 months, and expanded dental, vision and hearing benefits.
Outcome-based payments?
Looking forward, Beshear said it will be important to find a way to use “significant dollars” to incentivize and reimburse Medicaid providers who have good patient outcomes, as opposed to the current model of reimbursing them only for the care they provide.
“How do we create the best platform and structure to make this happen?” he pondered. “And that’s going to be what we’re looking at, really closely. … Again, if we can move towards a model where we reward outcomes, I think we can do significantly better.”
Beshear also spoke about the importance of preventive screenings as a way to improve health outcomes, pointing to Lt. Gov. Jacqueline Coleman’s experience as an example of their importance. Coleman recently underwent a double mastectomy after concerns were raised during a routine physical examination.
“That shows just how critical and important that is,” he said.
Legislative issues
When it comes to controversial health issues, like “red-flag” laws or abortion, Beshear said it’s important to approach these topics from a place of “basic human empathy” where people can find common ground.
Beshear said he supports a red-flag law, which allows temporary confiscation of an individual’s firearms if a judge finds that person is a risk to themselves or to others. A bipartisan bill to enact a version of the law is planned for introduction in the General Assembly session that begins Tuesday, Jan. 2.
But first, the governor said, he would like to stop the auctioning of murder weapons to the highest bidder. He said his support for such laws has grown stronger since the loss of a close friend, Tommy Elliott, in a mass shooting at the Old National Bank in downtown Louisville.
“I know what it’s like to lose a very close friend in a mass shooting,” he said. “I know what it feels like to have someone who you love and care about murdered and taken from you.”
Beshear said it is imperative for the legislatuire to add rape and incest exceptions to the state’s near-abortion ban, along with an exception for non-viable pregnancies.
“There are kids right now that have been raped and impregnated by family members that don’t have any options,” he said. “Hadley said it right, she wasn’t the first and she wasn’t the last. There are Hadleys out there right now and they deserve better.”
Hadley Duvall, who was sexually abused by her stepfather for years and became pregnant at age 12 and eventually miscarried, appeared in an ad for Besehear’s re-election campaign where she said, “To tell a 12-year-old girl she must have the baby of her stepfather who raped her is unthinkable.”
Beshear’s Republican opponent, Attorney General Daniel Cameron, responded to that attack by asking Beshear in a debate and afterward how far into a pregnancy a woman should be allowed to get an abortion.
In his campaign and in the interview, Beshear wouldn’t say, and turned the tables: “I believe in access, but that’s not what we’re going to see from this General Assembly,” he told Kentucky Health News. “I believe in access with reasonable restrictions. That’s not where we are. We are at zero access.”
In the interview and several others this month, the Democratic governor said he thinks he and Republicans who run the legislature can have a more cooperative relationship because he can’t seek re-election in 2027.
“This is the period of time when we can get these things done and not to be seen as a benefit or a detriment, politically,” he said. “And I’m already seeing a little difference in tone, and that’s everyone. … I think we’re seeing just a different tone and willingness to talk or to … talk differently.”
(Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.)
