Kentucky House debate puts Alvarado's nursing home record and Medicaid cuts on stage

With a week left before Election Day, the two candidates for Kentucky's 6th Congressional District met Tuesday night on a high school stage in Irvine. Republican Dr. Ralph Alvarado and Democrat Zach Dembo took questions from students at Estill County High School. A junior, Lincoln Wilburn, moderated ¹².

The students asked about inflation, Medicaid, housing and education ¹². But the sharpest exchange was over health care for older and lower-income Kentuckians, and over Alvarado's past work as a medical director for nursing homes ²⁴.

On tapeFOX 56 News · Oct 23

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Medicaid cuts and rural hospitals

Medicaid is the joint federal and state health program for people with low incomes. Dembo said he would restore the Medicaid cuts in the Republican tax and spending law known as H.R. 1 ¹². That law extended earlier tax cuts and added deductions for tips and overtime. It also cut spending on food aid and Medicaid and narrowed who qualifies ³.

We have a law that's about to go into effect in 2027 that could kick 200,000 Kentuckians off their Medicaid

Dembo said "26% of us in this district rely on Medicaid. 50% here in Estill County." ¹ He also said he opposed a proposed $900 billion Medicaid cut that he said could curtail services at 35 rural hospitals ².

From Channel GOPThe bill cut Medicaid for billionaire tax breaksKamala Harris · 135 plays · captioned, with the source named

Alvarado answered by pointing to $50 billion for rural hospitals in H.R. 1, and he said Dembo opposed it ². He blamed the Affordable Care Act, the 2010 health law, for the health system's problems and said new money would not fix it ¹².

Just to add more money in on top of a broken foundation, that house will collapse and fall.

Alvarado said he would hand control of Medicaid back to the states, create a federal fraud auditor and break up insurance companies ². He also came out against Medicare for All, which he claimed would cost trillions over a decade ².

A promise on Social Security, with no details

Alvarado said he would fully fund Social Security to "keep our promises to our seniors," and cut fraud and waste ². The debate coverage does not say how he would do that ¹².

At the first debate, held Oct. 22 in Lexington, Alvarado said he would have voted for H.R. 1 ³. Dembo said he would support tax breaks on tips, overtime and Social Security if they came as separate bills ³.

That matters because seniors keep hearing promises to protect Social Security. Alvarado's pledge to fund the program by cutting "fraud and waste" is not a plan, and older voters may want to ask candidates for specifics.

The nursing home record

Dembo accused Alvarado of backing Medicaid cuts and of leading nursing homes that were fined for substandard care ¹. He also said Alvarado was implicated in a Medicare fraud lawsuit ². Alvarado called the ads false. He said he was hired to bring facilities up to 3-, 4- and 5-star quality ratings ¹².

The Lexington Herald-Leader fact-checked a Dembo ad on these points on Oct. 15 ⁴. The paper found that while Alvarado was a state senator, from 2015 to 2023, he was also medical director for nearly half a dozen Central Kentucky nursing homes that state inspections showed had serious quality-of-care problems ⁴. The paper rated the ad accurate ⁴.

In the Senate, Alvarado chaired the Health and Welfare Committee. He pushed bills to limit medical malpractice lawsuits, including a law creating "medical review panels" that the Kentucky Supreme Court struck down as unconstitutional in 2018 ⁴. He also opposed proposed minimum staffing rules for nursing homes ⁴.

The concern I have with staffing ratios is that most facilities, even if they wanted to, they can't keep up with that

Alvarado told the Herald-Leader at the time that his bills covered the whole health care industry, not just nursing homes ⁴. The paper also noted that it did not find he passed a law aimed specifically at shielding nursing homes ⁴.

What the Medicare case actually showed

The fraud claim goes back to a federal civil case. In 2015, a Lexington home health company, Nurses Registry and Home Health, settled for $16 million ⁴⁵. Prosecutors said it broke the law by giving doctors gifts to win patient referrals ⁵.

According to court documents, Alvarado received $12,000 in campaign contributions between 2004 and 2010, plus University of Kentucky basketball tickets and a gift basket in 2010 ⁴⁵. He was not named as a defendant and was never charged ⁴⁵. On Tuesday he dismissed the allegation as "a Christmas fruit basket worth $56." ¹

His campaign spokesman, Andy Westberry, called the Herald-Leader's coverage "shoddy" and "biased" ⁴. He said "Dr. Ralph Alvarado has been a practicing physician for 30 years, earning a sterling reputation" ⁴.

A district in play

Donald Trump carried the district by 15 points, and forecasters still give Alvarado the edge ³. Five polls sponsored by Democrats in October showed Dembo ahead by 3 to 9 points ³.

Dembo is a Navy veteran and a former federal prosecutor and eighth-grade teacher ²³. Alvarado was Matt Bevin's running mate for lieutenant governor in 2019 and later served as Tennessee's state health commissioner ⁴⁵.

I will never vote to shutter our rural hospitals.

Early in-person voting starts Thursday, Oct. 29, and runs through Saturday ³.

The Record

1. Feb 6, 2019AP reported that federal authorities named Alvarado, then Matt Bevin's running mate, among about a dozen doctors who received gifts from a home health company that settled a civil suit for $16 million in 2015. He was not charged ⁵.
2. Oct 15, 2026The Lexington Herald-Leader rated accurate a Dembo ad saying Alvarado was a nursing home medical director while serving in the state Senate ⁴.
3. Oct 22, 2026Alvarado and Dembo held their first debate in Lexington; Alvarado said he would have voted for H.R. 1 ³.
4. Oct 27, 2026At the debate held at Estill County High School, Dembo warned that a 2027 law could cost 200,000 Kentuckians their Medicaid, and Alvarado called the nursing home attacks false ¹².
5. Oct 29, 2026Early in-person voting begins in Kentucky and runs through Saturday ³.

Sources

1. WKYT, “Kentucky 6th District candidates Alvarado, Dembo debate costs, health care in Estill County” (2026-10-27). wkyt.com/2026/10/28/kentucky-6th-district-candidates-alvarad
2. WKYT, “Alvarado, Dembo answer student questions in Estill County congressional debate” (2026-10-27). wkyt.com/2026/10/28/alvarado-dembo-answer-student-questions-
3. Louisville Public Media, “Dembo, Alvarado debate AI, tax cuts and healthcare in Kentucky race for US House” (2026-10-22). lpm.org/news/2026-10-22/dembo-alvarado-debate-ai-tax-cuts-an
4. Lexington Herald-Leader (via Yahoo News), “Fact check: What did Ralph Alvarado do for nursing homes while in the KY Senate?” (2026-10-15). yahoo.com/news/politics/articles/fact-check-did-ralph-alvara
5. AP via WKMS, “Bevin Running Mate Mentioned In Medicare Fraud Lawsuit” (2019-02-06). wkms.org/government-politics/2019-02-06/bevin-running-mate-m

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