Kentucky can't waste any chance to improve the health of its people. If you doubt it, study the map below. Women 75 and younger in much of Kentucky are living shorter lives than in the past.
Rural women in other states are experiencing similar shortened life spans, according to University of Wisconsin researchers, though the decline is especially pronounced here. How could this happen in the world's richest country where per capita spending on health care exceeds all others by far?
We could trot out other depressing indicators — from frequency of diabetes to tooth decay — to explain why Gov. Steve Beshear made the right choice — the only choice, really — by expanding Medicaid.
An additional 300,000 Kentuckians will become eligible for free health care.
Another roughly 300,000 uninsured Kentuckians with higher incomes will be eligible to buy subsidized health insurance on an exchange that opens Jan. 1.
Insurers will no longer be able to reject people with pre-existing conditions and will cover comprehensive preventive care.
In a godsend to places and people ravaged by addiction, Kentucky will have more mental-health and substance-abuse treatment.
Beshear's economic analysis shows that though state government will have to pay 10 percent of the cost by 2020, the Medicaid expansion will pump $15.6 billion into the state's economy by then, add 17,000 jobs and end up putting more tax revenue into state coffers than it takes out. (If the predictions don't pan out, the expansion can be scaled back or ended.)
All this is made possible by the Affordable Care Act, the reform that Republicans dubbed Obamacare and that they love to hate.
By next year, for the first time, all Kentuckians could have access to affordable health care. No wonder Beshear choked up making the announcement.
But here's something that should be even more moving: Universal access won't make a significant difference in Kentuckians' health unless health care changes.
Some good ideas are swirling around, but they won't take shape without strong leadership from the state, and that means Beshear.
Much of Kentucky already suffers from shortages of primary care. Preparing a medical home for every Kentuckian will take hard work, from the loftiest medical faculty to the community and technical colleges, in order to create the capacity and work force to meet the new demand.
The whole system must become more efficient and quality conscious.
Small hospitals must change, says rural health expert Dr. Wayne Myers, from sick houses to centers of health.
More prosaically, Beshear must fix his managed care Medicaid. The administration seems to be making quick headway on the promises Beshear made when he vetoed a bill that would have clamped down on the private contractors.
But if privatized Medicaid still has weak provider networks and persistent payment delays when 300,000 new patients come on board next year, it will be a disaster.
One thing is certain: The profit-driven companies that are managing Medicaid can't and won't provide the leadership demanded by this potentially transformational moment.
Republicans in Congress and the legislature will keep sniping and threatening to withhold funding. They also should think of their constituents, Kentuckians who are suffering more and dying sooner than they should have to.