No state has gained more than Kentucky from President Barack Obama’s Affordable Care Act. No state stands to lose more from its repeal by the Republicans who won control in November.
Space does not permit a full accounting of the good the ACA has done here. Some highlights:
▪ An additional 635,000 Kentuckians have access to substance-abuse treatment.
▪ In the No. 1 state for cancer, more low-income Kentuckians are getting cancer screenings.
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▪ Insurers can no longer exclude or price out individuals with pre-existing medical conditions.
▪ The percent of adult Kentuckians who have no health insurance has declined from 15 percent to 6 percent.
All this is invisible to Senate Majority Leader Mitch McConnell, who has yet to publicly acknowledge what his constituents would lose if Republicans wipe out Obama’s health-care legacy.
The ACA’s greatest impact in Kentucky came through expanding Medicaid, the government health program, to cover able-bodied adults with yearly incomes up to 138 percent of poverty or $16,243 for an individual.
In his voluminous denunciations of the ACA, McConnell almost never mentions Medicaid, and when he does it’s to bemoan the “many who’ve been forced into Medicaid.” Same for Rep. Andy Barr, R-Lexington. As if 425,000 working-poor Kentuckians had to be forced into diabetes treatment or having their abscessed teeth repaired.
In McConnell’s world, the 8,597 Kentucky women who received breast cancer screenings in the second quarter of 2016 thanks to the Medicaid expansion would have preferred mastectomies, chemotherapy or an agonizing death, at a higher cost to everyone. In those same three months, 32,968 Kentuckians were subjected to a dentist’s care and 3,754 were screened for hepatitis C, thanks to the repressive Medicaid expansion.
The cost of uncompensated care to Kentucky hospitals (services for which they were not paid) declined from $2.6 billion in 2013, the year before the Medicaid expansion, to $552 million in 2015.
Gov. Matt Bevin voiced confidence last week on WHAS radio that the still-to-be determined replacement plan will continue the tradition of indigent care, saying “Have you ever seen anyone in the United States of America dying on the side of the road for lack of medical care?” Maybe not, but without health insurance, Americans routinely perish in hospitals from diseases that would have been survivable if they had been discovered earlier or managed better.
Republicans can’t come up with a replacement until they’re anchored in reality. Health-care costs are increasing at the lowest rate in decades. But one of the favorite talking points is that the ACA is driving up health-care costs. Republican critics also blame the ACA for soaring deductibles and co-pays that people in insurance plans outside the ACA exchanges are also experiencing.
The ACA is not perfect. Americans’ health care remains at the mercy of insurance and pharmaceutical industry profits. Medical providers too often harm patients and waste resources. Kentucky’s dismal health picture could take a generation at least to turn around.
But the ACA moved us closer to a rational, humane system. If the Republicans can come up with something that covers as many people at less cost, we, like Obama, will support it. So far, nothing like that is in sight.