A poor, sick state like Kentucky can't afford to base health care policy on stubborn ideology or paranoid fantasy of the sort heard at a Tea Party rally on the legislature's opening day.
Rants about the freedom-stomping evils of the Affordable Care Act, also known as Obamacare, may have made good election-year fodder.
But the election is over, the law is not going away and it's time for responsible leaders to lead.
One of the biggest questions raised by the reform act — whether to expand Medicaid — is really no question at all. How could Kentucky refuse an offer by the rest of the country to pay 90 percent of the medical coverage for almost 300,000 low-income adults?
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The federal government will initially pay the entire cost. Eventually the state will have to pick up 10 percent.
Yes, Medicaid is already a huge burden in a painfully strained state budget. But these are problems to be solved, not insurmountable obstacles or ideological lines in the sand. Kentucky has to wrestle with Medicaid costs and management, whether there's an expansion or not.
Kentucky stands to benefit more than any state from the Medicaid expansion, says the Kaiser Family Foundation, as more than half of our almost one in five uninsured adults gain coverage. These are working people who can't afford or don't have access to insurance.
The federal dollars that would come from expanding Medicaid to cover more people would create jobs in health care, while a healthier work force would be more productive and less of an economic drag.
The Urban Institute projects Kentucky would reap health care savings from a Medicaid expansion as less money would go into emergency care for the uninsured.
The cost of caring for the uninsured now adds an average $1,000 a year to the cost of private insurance for an individual.
Kentuckians who are not eligible for the Medicaid expansion will benefit from a new health insurance exchange which will provide comparison shopping and help individuals and businesses learn about and obtain tax credits and subsidies.
The state Chamber of Commerce, Kentucky Hospital Association and Kentucky-based insurers prefer a state-run exchange.
We don't care whether Kentucky defaults into a federally run insurance exchange or proceeds with Gov. Steve Beshear's creation of a state exchange.
What does matter, as lawmakers and the administration wrestle with reform's details, is that they are guided by empirical evidence, common sense and, dare we hope, a spirit of innovation.
The legislature has some smart people, Republicans and Democrats alike. They have to keep the health care debate on the rails of reality and not let it be sidetracked by ridiculous fears — such as 16,500 armed IRS agents will enforce Obamacare — that were on display when 50 or so people protested the health care reform Wednesday.
(We're not discounting the power of the IRS, but its most fearsome weapons are the audit and subpoena.)
Kenny Colson of Kentucky Public Radio reported that one of the protesters, Kathy Gornik, chair of the Bowling Green-based Bluegrass Institute for Public Policy, called for "a return to free market principles, where the patient is the employer of the physician and the physician is obligated only to the patient."
We're not sure how far back you'd have to travel to reach that health care nirvana.
The reality on the ground today is that physicians and patients are at the mercy of a complex web of private insurance companies and government programs and that almost one in five Kentuckians has no health coverage.
Instead of looking for excuses for saying no, our elected leaders should be searching for ways to use the federal law to bring better, more cost-efficient care to more of their constituents.