Carrie Banahan

Philip Andrews

The rollout of the federal HealthCare.gov insurance exchange last year was a disaster. Users were met with site crashes and interminable wait times. For many of the states that launched their own exchanges, the story was the same. The sites spat back error messages at consumers, many of whom ultimately gave up out of frustration. 

But one of the few states that got everything right was Kentucky. And that’s due to the work of Carrie Banahan. 

When Gov. Steve Beshear in 2012 decided that his state would create its own exchange, he knew he needed the right person in charge of the new project. Kynect, as the state’s initiative is known, would be a complex online marketplace integrating Medicaid and subsidized private insurance plans aimed at the 1-in-5 state residents who had no health coverage. “It has so many moving parts,” says Beshear. “It really requires an understanding of the Medicaid program, health policy and Kentucky insurance laws. There aren’t many people here who have that kind of background.”

Banahan fit the bill perfectly. A 32-year veteran of Kentucky state government, she had served as deputy commissioner of the Department of Insurance and, later, as the deputy Medicaid commissioner, before becoming Beshear’s chief health policy adviser. 

When Kynect went live October 2013, Kentucky was the only Southern state with its own health exchange and one of only two that were opting to expand Medicaid coverage under the Affordable Care Act. Unlike the flailing federal exchange and the error-prone sites in other states, Kynect worked. By the end of open enrollment, more than 413,000 people signed up, with about 80 percent of them placed in Medicaid. In a state with some of the country’s highest rates of smoking, obesity, chronic disease and poverty, the rate of uninsured was nearly cut in half, marking the second-highest drop in the country. 

Kentucky’s success is the result of some key decisions. For starters, while other states opted for high-end customization, Banahan insisted on simplicity. For instance, Kynect allowed users to browse for plans and get introductory eligibility determinations without formally creating accounts, which helped prevent the bottlenecks that paralyzed other exchanges. Integrating Medicaid and private insurance enrollment under one platform required major technological upgrades, but it also allowed Kentucky to avoid the backlogs that piled up for other states.  

Banahan sold Kynect relentlessly to the public, crisscrossing the state to talk up the exchange at high school football games, fall festivals and local TV stations. Thanks to her outreach, Kynect became a familiar brand that Kentucky citizens identified with. And she kept close tabs on contractors, housing them in a basketball-court-sized room that served as Kynect’s central command. When some states started threatening to sue their contractors, Kentucky commended theirs. 

“It was a kismet, an aligning of stars, a case of everything being in the right place at the right time -- call it what you want,” says Regan Hunt, executive director of Kentucky Voices for Health. “Carrie was a big part of that.” -- By Chris Kardish

Read about the rest of the Public Officials of the Year here.