After years — decades, really — of talking about health care reform in this country, a long-awaited piece finally is falling into place as Kentucky's health insurance exchange starts up today.
There are bound to be glitches and confusion when something this big launches. Plus, there's a well financed effort to malign the reforms and mislead the public. The inevitable bugs should not obscure the importance of the moment:
Life is about to get better for hundreds of thousands of Kentuckians who have been unable to afford preventive care and have lived just one bad accident or surgery away from bankruptcy.
Gov. Steve Beshear and his administration deserve a lot of credit for maximizing this historic opportunity.
Kentucky is the only Southern state that is taking full advantage of the Affordable Care Act by both expanding Medicaid to include an estimated 308,000 working-poor Kentuckians and by creating a state insurance exchange where an estimated 332,000 uninsured Kentuckians will be able to shop for discounted coverage.
As Beshear wrote last week in The New York Times, Kentucky, which ranks near the bottom in almost every indicator of public health, "couldn't afford not" to take full advantage of the Affordable Care Act and "frankly . . . can't implement" it "fast enough."
It's inexplicable and shameful that so many Republicans in Congress are still trying to stop the health care reform law — and are even willing to inflict a government shutdown or default to get their way.
Congress enacted the law in 2010; the Supreme Court upheld it. Republican Mitt Romney promised to repeal it, but the electorate rejected him by 5 million votes last year while choosing a Congress that lacks the votes for repeal.
The law's not perfect and will need tweaking. Some on the left view it as a way station on the road to a single-payer system. If it's as economically catastrophic as some Republicans predict, it won't last.
But the Congressional Budget Office predicts the new law will reduce the deficit. Congress did pay for it, unlike the Medicare prescription drug benefit, by taxing various parts of the health care industry which stand to gain from an influx of newly insured customers.
The law has provisions for containing health care costs which are the biggest drag on the economy and government budgets. And the ability to afford health insurance will free would-be entrepreneurs to leave jobs with benefits to start their own new businesses, which will help the economy.
It's worth remembering that both major parties' candidates for president in 2008 promised health care reform that would provide universal or near universal coverage. It's also worth remembering that the plan that has come to be known as Obamacare was developed by the conservative Heritage Foundation which recommended a requirement that all adults obtain health insurance or pay a penalty.
It's not a free ride. The exchange's cheaper policies will come with higher deductibles and out-of-pocket costs. But out-of-pocket costs are capped, which will protect people from the kind of enormous medical bills that are the top cause of personal bankruptcies in this country.
Kentuckians have until Dec. 15 to sign up for coverage that starts Jan. 1.
Meanwhile, critics should offer constructive changes or, as Beshear wrote for a national audience, "Get over it ... and get out of the way" so people can get the help they need.
"Here in Kentucky," the governor said, "we cannot afford to waste another day or another life."
He is right.