Kentucky is a state that's had direct experience with both the state and federal systems.
The state version was launched in 2013 under former Gov. Steve Beshear. It was dismantled in 2017 under his successor, Republican Matt Bevin, then reopened under now Gov. Andy Beshear in 2020.
Wednesday, Republican lawmakers questioned officials with Kynect about costs and whether maintaining the exchange and its accompanying system of local navigators is preferable to handing insurance seekers off to the federalhealthcare.gov site.
Rep. Ken Fleming expressed concerns about identifying people who are improperly enrolled.
"I know part of the thought — in terms of going from a fed to state — is more control, more flexibility for you all to dictate. I get that. But also, on the other side of the coin, you have the federal market that's more strict and has whole lot more data databases and data resources in order to look at eligibility to verify things," he stated.
But Health Commissioner Dr. Steven Stack later argued that the state-based system has proven its value.
"We believe that people should only get access to the services for which they're eligible, but we also then believe Kentuckians rely on us to help them navigate an overly complicated system so they actually get access to the things that they are eligible to receive," he said. "One of the reasons I think we would assert it is incredibly valuable and why it's important to continue to maintain a state-based approach is because we make it easier for citizens to access multiple benefits through one point of contact."
It's far from a new debate. And with a now term-limited Democratic governor, Republicans may be looking to restart that conversation, should the GOP retake the Governor's Mansion in 2028.