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Bill Straub: Finally, something to be proud of besides basketball, bourbon and fast horses

WASHINGTON – An old, nasty joke has it that Kentucky should change its motto from “United We Stand, Divided We Fall’’ to “Thank God for Mississippi,’’ given the commonwealth’s lowly standing on a number of quality of life issues, with only the Magnolia State positioned between the Bluegrass and the bottom.

So when Kentucky outperforms other states in areas other than college basketball, bourbon and fast horses – essential characteristics, I grant you, but play along for a bit – due notice should be taken. And with a grand new year underway, now should prove to be as good a time as any.

Kentucky, despite its myriad challenges, has assumed a leading and successful role in implementing the Affordable Care Act, expanding health coverage to hundreds of thousands of the commonwealth’s residents who might otherwise be forced to gamble by going without. Kynect, the health benefits exchange created to implement the law, now serves as a national model.

Writing in the Nov. 20, 2014, edition of the widely respected New England Journal of Medicine, Dr. Michael D. Stillman, a physician with the University of Louisville Department of Medicine, asserted that “our commonwealth’s citizens — among the poorest and most underserved in the country — finally gained broad access to health insurance’’ as a result of the ACA.

Obamacare, as it is commonly called, “fundamentally altered our medical practice, allowing us to provide data-driven and thorough care without first considering our patients’ ability to pay,’’ he offered.

Before the ACA, Stillman wrote, the “650,000 Kentuckians who lacked health insurance received disjointed and disastrous care. They could be seen in subsidized facilities and be charged for their visits on a sliding scale, but they were asked to pay in advance for most diagnostic tests and consultations. Many of them avoided routine and preventive care — and worried that a medical emergency would leave them bankrupt.’’

That has changed. Stillman said many of his low-income patients are now seeking “for the first time as adults…non-urgent medical attention.’’ He recently examined a 54-year-old man with various complaints “whose last physician visit had been with a pediatrician.’’ Before Obamacare the man would have been unable to pay for the appointment and lab work.

“Newly insured, however, he was able to afford the tests and medications that most Americans would expect to receive, and he told me he felt proud to have witnessed a sea change in health care delivery in Kentucky and that recent reforms seemed ‘just,’’’Stillman said.

Finally, something for Kentuckians to pound their chests over other than a two-handed slam by Willie Cauley-Stein. The most recent enrollment period ended with 413,000 residents using Kynect to obtain health insurance, either through the marketplace or as a result of Medicaid expansion. The state estimates that about 75 percent of the applicants lacked any insurance and were unable to access needed care before signing up.

On top of all that, a joint study by the PriceWaterhouse Coopers accounting firm and the Urban Institute at the University of Louisville determined that Medicaid expansion under the ACA could add $15 billion and 17,000 jobs to the state’s economy over the first eight years of implementation.

Gov. Steve Beshear deserves credit for seeing this through, without any codicil. He stuck his neck out and championed the program at a time when it appeared the entire enterprise might be headed south. The governor hasn’t always acted with political courage (see same-sex marriage, coal), but he merits all the kudos he can reap on this one.

And, of course, there is the commonwealth’s congressional delegation, charged with looking after the best interests of its constituents in Washington.

The leader of the pack, Senate Republican Leader Mitch McConnell, of Louisville, who will soon lead the majority in the upper chamber, maintains “the best interests of the country would be achieved by pulling out Obamacare root and branch.”


The Affordable Care Act, McConnell insists, “is the worst piece of legislation in the last half-century.”

McConnell is not alone in his assessment.

“Obamacare is expensive, unconstitutional and threatens our First Amendment right of conscience,” said Rep. Thomas Massie, R-Lewis County, failing to note that the U.S. Supreme Court differs with him on the issue of constitutionality.

Rep. Andy Barr, R-Lexington, said he has continually voted against Obamacare “because it is full of broken promises.’’

Rep. Brett Guthrie, R-Bowling Green, who likewise has voted to repeal Obamacare and will serve in the 114th Congress as vice chair of the House Subcommittee on Health, told WKYU-FM in Bowling Green that he anticipates a major rewrite of the health care law this session.

“The people of Kentucky have to understand that 400,000 people were given health insurance with zero obligation to work for it,” Guthrie said. “I mean, there’s no obligation to show up for work in any capacity to get this expansion of health care. And I just think that’s untenable.”

In fact, both of the commonwealth’s U.S. senators and five out of the six House members, the exception being Rep. John Yarmuth, D-Louisville, have voted to repeal the law that holds promise for a healthy future in Kentucky.

Yarmuth said voting for the Affordable Care Act was “my proudest moment in Congress.’’

“During my time in Congress, an overwhelming majority of Louisvillians have told me they want guaranteed access to health care, lower premium costs and more choice in the insurance market,’’ Yarmuth said. “The Affordable Care Act accomplishes each of these goals.’’

The other lawmakers bring to mind the biblical verse Jeremiah 5:21: “Hear now this. O foolish people and without understanding; which have eyes, and see not; which have ears, and hear not.’’

Or, as philosopher Soren Kierkegaard said, “There are two ways to be fooled. One is to believe what isn’t true. The other is to refuse to accept what is true.’’

Kentucky’s congressional delegation, with one exception, obviously has opted for the latter.

Meanwhile, in Mississippi, which has refused to embrace Obamacare and rejected federal funds to expand Medicaid, things that were bad have only gotten worse. Already the nation’s unhealthiest state, according to Kaiser Health News, Mississippi is the lone spot in the nation where the percentage of uninsured residents has gone up, not down.

It was Gov. Phil Bryant who determined that Mississippi would not expand Medicaid, thus leaving 138,000 residents, mostly African-Americans, with no insurance options.

Perhaps Kentucky should consider changing its motto, this time to, “There but for the grace of God…’’



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KyForward Washington correspondent Bill Straub served 11 years as the Frankfort Bureau chief for The Kentucky Post. He also is the former White House/political correspondent for Scripps Howard News Service. He currently resides in Silver Spring, Maryland, and writes frequently about the federal government and politics. Email him at williamgstraub@gmail.com.

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