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A closer look: Kentucky may not be an ACA pace-setter, after all

January 28, 2014

    Dan Diamond, Managing Editor

    For months, Kentucky has been held up as a national example of how a state can successfully expand coverage under the Affordable Care Act. That reputation began to form as early as the first day of October: As other states struggled to get their insurance exchanges up and running, Kentucky's Kynect marketplace announced that thousands of people had signed up, strong enrollment numbers that seemingly continued every day for weeks.

    (Making those figures even more striking is that residents of Kentucky—as a southern, conservative-leaning state—aren't seen as naturally receptive to the ACA.)

    As a resut, Kentucky's exchange received write-ups in the New York Times, the Washington Post, Modern Healthcare, and elsewhere. (I suppose the Daily Briefing counts under "elsewhere.") In a high-profile piece of praise, President Obama said the state had "done the best" at signing up enrollees. All the attention even helped Gov. Steve Beshear score an invitation to Tuesday's State of the Union, as a guest of first lady Michelle Obama, complete with a special mention from the president.

    "If you want to know the real impact this law is having," according to President Obama's prepared remarks, "just talk to Governor Steve Beshear of Kentucky."

    But as the early days of ACA exchange implementation recede, and Medicaid numbers remain separated from private plan sign-ups, a new picture is emerging of Kentucky: The state's strong enrollment numbers aren't really so different from its neighbors. In fact, they're lagging the pack.

    First, look at the above chart and compare Kentucky to neighboring states like Ohio, Tennessee, and a few others that used the much-maligned healthcare.gov website to try and sign up residents. As a total, the state's enrollment numbers don't look so special; as a percent of HHS's goal, Kentucky actually falls behind.

    What's the state of ACA implementation? Join us for a conversation on March 19 as our experts perform a pulse check on Obamacare.

    Or pull back to see how Kynect shapes up against the fourteen other states that ran their own exchanges. Collectively, those other states had hit about 66% of their enrollment projections through December 28—but Kentucky had hit about 32% of its projection, beating out only states with struggling exchange websites, like Oregon and Hawaii.

    Of course, this grading of Kentucky's progress reflects that the state had very ambitious sign-up goals in front of it. HHS expected that more than 103,000 people would enroll in private coverage through Dec. 28, which was a higher target than in more populous states like Pennsylvania and New York. (When judged against a more moderate target, like enrollment as a share of the eligible population, Kentucky shakes out among the nation's top 10.)

    But Kentucky's prominence in ACA coverage, and Beshear's presence at the State of the Union, reflect perception that the state had some secret recipe for exchange success. And on closer look, the perception doesn't quite match what the actual numbers bear out.

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