Fact check: What would Dembo and Alvarado do to make healthcare accessible?

In our Reality Check stories, Herald-Leader journalists dig deeper into questions over facts, consequences and accountability. Read more. Story idea? hlcityregion@herald-leader.com.

The good healthcare news for Kentuckians is that more have access to it than they did a decade ago when then-Gov. Steve Beshear, a Democrat, expanded Medicaid to the working poor and established Kynect, the state’s health insurance marketplace. Today, about 93% of Kentuckians have insurance, up from about 85% in 2013.

The bad news is that broader insurance coverage hasn’t stopped medical and dental costs from soaring to about $10,000 a year per Kentuckian, according to one study. Even with insurance, Kentuckians spend about 13% of their incomes on health care.

The worse news is that Kentuckians are an ailing people, with some of the nation’s lousiest rates for obesity, diabetes, heart disease, cancer, tooth decay and mental distress.

So the Herald-Leader asked the two major party candidates for Central Kentucky’s 6th Congressional District what they would do, if elected, about healthcare access and affordability.

On a recent Thursday afternoon, former federal prosecutor Zach Dembo laid out a five-point healthcare plan at a news conference in Paris attended that was by Steve Beshear and several medical professionals.

- Reverse the roughly $1 trillion in spending cuts to Medicaid and the Children’s Health Insurance Program over the next decade that President Donald Trump won in his One Big Beautiful Bill Act in 2025. Dembo called the cuts “catastrophic.” He said they could force 200,000 Kentuckians out of Medicaid and close 35 rural Kentucky hospitals, including Bourbon Community Hospital just down the street from his event.

“People rely on these hospitals for healthcare,” Dembo said.

“They rely on it to be able to get the primary care they need,” he said. “And we know if this hospital closes and folks have to travel farther, or if the Fleming County Hospital closes and they have to travel farther, something that could be treatable like sepsis could become a fatal condition if it takes too long for them to get the care they need. Why would we ever be attacking rural hospitals?”

- Restore premium subsidies that Congress let expire Jan. 1 that made insurance cheaper for roughly 20 million Americans enrolled in an Affordable Care Act marketplace plan. Congressional Democrats forced a government shutdown to save the subsidies last year before they ultimately surrendered to the Republican majorities.

- Require price transparency for medical procedures so patients will know in advance exactly what they’ll be expected to pay instead of getting surprised for months afterward as the bills arrive. The federal government already has made several attempts to require healthcare price transparency in recent years, but with mixed results at compliance. When prices are provided, they sometimes can be confusing or inaccurate.

- Authorize the federal government’s Medicaid and Medicare programs to negotiate with pharmaceutical companies for lower prescription drug prices across the board for the 137 million Americans enrolled in those programs.

This wouldn’t be unprecedented. The military’s TRICARE program and the U.S. Department of Veterans Affairs already negotiate on drug prices. And under the Inflation Reduction Act of 2022, Medicare can bargain over a handful of high-priced drugs.

- Add a “public option,” a government-backed health insurance plan to compete with private insurers for people who either don’t like their employer’s plan or don’t have access to an employer’s plan. Public options at present are mostly limited to Medicare, which serves seniors age 65 and up, and Medicaid, for the poor and disabled.

Ralph Alvarado, a Winchester doctor and former Kentucky state senator, did not respond to requests for comment for this story.

However, being a doctor, Alvarado has had plenty to say elsewhere about healthcare.

While in the Kentucky General Assembly and working as medical director for several low-rated nursing homes, he sponsored bills to make it harder for people to sue for medical malpractice. One of those bills, requiring “medical review panels” to approve malpractice lawsuits before they could proceed, was struck down as unconstitutional by the Kentucky Supreme Court in 2018.

Alvarado describes himself as a Make America Healthy Again advocate who has conversed with U.S. Health and Human Services Secretary Robert Kennedy Jr., leader of the MAHA movement.

Like Kennedy, Alvarado says he recommends exercise, good nutrition and religious faith. He opposes mandatory vaccinations. During the COVID-19 pandemic, he sponsored measures in the state Senate that would have recognized a positive COVID antibody test showing past exposure to the virus as the equivalent of COVID vaccination.

“I think it’s good health policy to administer vaccines, but if people don’t want them, we shouldn’t force people to take them,” he told a 2019 Northern Kentucky Tea Party gathering. “You should have the right to say no if you don’t want that for your kids.”

Vaccines have become more controversial under Trump and his vaccine-skeptic supporters, but pediatricians still recommend vaccinations for children entering school to curb the spread of disease.

Kentucky public health officials so far this year have reported 53 measles cases and seven hospitalizations — the state’s largest outbreak in decades — largely among people who either were unvaccinated or whose vaccination status was unknown. Likewise, the U.S. has recorded over 3,100 measles cases so far in 2026.

In a campaign ad, Alvarado — like Dembo — pitches the idea of healthcare price transparency, pledging to make insurance companies “post every price up front.” He compares the current healthcare system to someone trying to buy a steak at a restaurant and not knowing if it’s going to cost $10 or $1,000.

In some interviews, Alvarado has argued for greater use of “concierge medicine,” a popular practice with some affluent patients who put a personal physician on retainer, pay that doctor directly and cut out the insurance company. Such deals allow full price transparency, he says, and doctors often charge less in exchange for not having to deal “with the stress of insurance companies.”

One of the things Alvarado said he talked to Kennedy about was the need for states to have more control over healthcare spending inside their borders instead of the federal government. The federal government spends more than $15 billion a year on Medicaid alone in Kentucky.

During a recent three-year stint as Tennessee state health commissioner, Alvarado was criticized for rejecting about $9 million in federal funds for HIV programs. However, he told interviewers, he convinced the Tennessee legislature to replace those funds with state money, which could be spent for the same purposes with fewer strings attached.

“I will advocate for the importance of funding public health projects, but I do think that more of that needs to go to the states and less to the federal government,” Alvarado told the Washington Reporter in June. “I do believe in block granting money. I’ve had a chance to talk to RFK and to HHS about the importance of block granting money to the states and trusting them.”

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