Sunday, October 8, 2017

Far from the debates about Obamacare and Medicaid in Washington and Frankfort, Eastern Kentucky's poor see benefits

Kentucky Health News

The political debates over the future of Medicaid and the Patient Protection and Affordable Care Act sometimes obscure the human and economic impact of the expansion of Medicaid in Kentucky. That story can be told in any county; a national reporting project chose far Eastern Kentucky as the place to talk with patients, doctors, clinic managers and others, and its story was published on the front page of Sunday's Lexington Herald-Leader. It begins:
WHITESBURG — Lois Smith was paralyzed, but now she can walk again.
Smith, 62, had been to the emergency room off and on since she collapsed one day in her driveway about five years ago and found herself unable to walk. She was uninsured, on disability and incapable of paying a primary care doctor.
In 2013, she enrolled in Medicaid under the expansion created by the Affordable Care Act, also known as Obamacare, and has been seeing Dr. Van Breeding at Mountain Comprehensive Health Corporation in Whitesburg regularly ever since. Breeding determined she suffered nerve damage from diabetes. With treatment, Smith is now back on her feet.
Breeding told Eric Bosco of Crossing the Divide, part of The GroundTruth Project and Boston's WGBH, that his patient count has risen to 34,581 from 25,699 before Obamacare, and the percentage of his patients without insurance dropped to 4 percent, from 16 percent. "Screenings for colon cancer have risen from 19 percent to 60 percent of patients, the clinic now offers dental and vision care, and they are planning to open a Suboxone clinic to help address the opioid crisis," Bosco reports.

The clinic and other health-care providers have funneled billions of federal dollars into the state's economy, but state officials are trying to implement premiums, co-payments and work requirements, citing the state's increasing cost share, which will gradually rise from 5 percent this year to the law's limit of 10 percent in 2020.

"It’s also clear here that Obamacare has real problems," Bosco writes. "Health-care experts note that premiums have risen sharply for individuals purchasing insurance on the federal health exchange. Rising premiums also squeeze small businesses, 60 percent of which support repealing the law, according to a February survey by BizBuySell, a small business marketplace."

David Bolt, chief operating officer of the Kentucky Primary Care Association, "thinks much of the talk about the failings of the health law is political bluster," Bosco reports, quoting him: “The only part that is imploding at all is the individual market, a very, very small piece of the health care coverage.”

About 81,000 Kentuckians have individual insurance policies subsidized by Obamacare; 475,000 have been added to Medicaid by the expansion, which opened the program to anyone in a household with income less than 138 percent of the federal poverty line.

President Trump carried the formerly Democratic area easily, but Breeding "said he thinks many of his patients voted for Trump based on cultural issues, such as immigration, and promises of returning coal jobs," Bosco reports. "Meanwhile, Lois Smith and others who rely on expanded Medicaid wait anxiously to see what Washington does."

Smith told Bosco, “I’m worried, because you never know when they’re going to cut it off.”

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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