Republicans seized on a new report by the Kentucky Hospital Association as proof that the Affordable Care Act is "bankrupting Kentucky hospitals," as gubernatorial candidate Hal Heiner's campaign said, and is "bad for Kentucky, ... the middle class and ... our country,'' as Senate Majority Leader Mitch McConnell put it.
The Republican Governors Association tweeted that the hospital association's report also is "bad news" for presumptive Democratic gubernatorial nominee Jack Conway.
Politics aside, the white paper, "Code Blue: Many Kentucky Hospitals Struggling Financially Due to Health System Changes," voices a universal human desire: More money, less accountability.
The association implies that federal financial penalties aimed at reducing harm to patients are too onerous for hospitals that care for Kentuckians.
Based on consulting firm Dobson/DaVanzo's analysis, the report presents data from before 2014, the turning point when 500,000 Kentuckians gained health coverage under the Affordable Care Act. And it projects $1 billion in losses for Kentucky hospitals by 2020.
As for the present, little more than anecdotes are offered with no acknowledgment that some Kentucky hospitals are recording record bottom lines and steep drops in uncompensated care.
The Medicaid expansion made possible by the ACA pumped $506 million into Kentucky's hospitals in 2014.
The impact is evident when UK Healthcare's 2013 and 2014 first half results are compared. The 2014 period saw an 83 percent drop in non-paying inpatients, a 66 percent drop in non-paying outpatients and a $60 million increase in Medicaid revenue.
UK Healthcare's annual net income through March is up $70 million over the same time last year. Not all of that increase is due to the Medicaid expansion or kynect.
No one expects the windfall to last, as part of the cost of the Medicaid expansion shifts onto Kentucky in 2017.
But any Kentucky hospital now verging on bankruptcy had problems before the ACA.
Here's the important point: Slowing down spending on hospital care is one of the best things we can do for the economy and our health. The United States spends the highest percentage of its GDP on health care of any country but gets worse outcomes. Even by U.S. standards, Kentuckians overutilize hospital care.
Getting too much or the wrong kind of care can be hazardous. Just ask the patients who underwent thousands of unnecessary heart procedures until the feds blew the whistle on St. Joseph-London last year.
Funding models that push hospitals to become more quality conscious and efficient are good. KHA published a report last year by the same consultants detailing how Kentucky hospitals can adapt to the new demands, including keeping people healthier.
Yes, rural hospitals are under pressure to reinvent themselves. Not all will survive. Others are forging partnerships and figuring out how to better serve their communities' needs.
Kentucky has a long way to go to get healthy, but it's on the right track.
Other points to consider:
■ One of the KHA's suspect "anecdotal" findings is that as many as 20 percent of those covered by the Medicaid expansion previously had commercial insurance. An individual's annual income must be less than $16,000 to qualify for Medicaid. Some may have qualified after losing a job with health benefits or aging out of their parents' plan. But it's unlikely that 1 in 5 individuals earning less than $16,000 would have had private insurance. That did not stop McConnell from repeating the claim on the Senate floor last week.
■ KHA bemoans reductions in hospital staffs without acknowledging increases in overall health care employment.
■ The projected $1 billion loss by 2020 is predicated on reductions in federal payments for uncompensated care as more people gain insurance and become paying patients. The payment reductions have twice been delayed and may be delayed again, though, as we said, slowing down hospital spending would be a good thing.
■ The report attributes almost $1 billion in cuts to Kentucky hospitals over the next decade to federal sequestration, something McConnell is in a prime position to fix.
■ The KHA's recommendations for cost savings by standardizing Medicaid billing procedures are smart. The state should include them in new contracts with managed care companies.
"Code Blue," signaling a patient needs resuscitation, is an unintentionally fitting title because the KHA's credibility could use a little CPR.