In Floyd County, opinions about health care reform depend on whom you ask, and in some cases they are surprising

At the Eula Hall Health Center in Grethel,
nurse Stephanie Clark takes vitals of Mary
Murphy, 54, whose leg blood clot wasn't
treated for 15 years because she couldn't
afford it. (C-J photo by Jessica Ebelhar)

"A team of journalists from USA Today and The Courier-Journal has found that in Floyd County, Obamacare is a neither a train wreck nor a cure-all. It's a work in progress; widely misrepresented and misunderstood, it's helped some people and hurt others, while a handful seem unaffected." So write Chris Kenning and Laura Ungar of The C-J, with Jayne O'Donnell and Rick Hampson of the national newspaper of C-J owner Gannett Co. Inc.

Newly insured people are being treated for ailments that they long ignored or tried to treat with inadequate resources, and people who couldn't get or afford insurance because of pre-existing conditions have been able to get it. "Yet, also because of Obamacare, insurance customers in this Appalachian community complain about higher deductibles and insuring those who don't work. Many say they can't afford even subsidized plans on the state's insurance exchange," the writers report. "Some small business owners say they may cut workers' hours. And hospital leaders say the law has exacerbated health-care trends, leading them to lay off workers and shut down an entire floor of Floyd County's largest hospital."

Advocates say the health-reform law will improve Kentucky's health by bringing care to those who haven't had it, but "Obamacare so far shows scant promise of being able to heal Floyd County, where generations of poor health habits and attitudes testify to poverty's victory" despite the "war" on it that President Lyndon Johnson declared in the region 50 years ago. "Real change, many say, will take decades, given the county's poor health: 35 percent of adults smoke, and the overall death rate is 42 percent above the national average. Many lack reliable transportation, have trouble taking time off from low-wage jobs for medical appointments or just don't believe in going to the doctor."

Some say the law didn't go far enough, and worry about its effect on hospitals. "It's insurance reform," said Bud Warman, president of Highlands Regional Medical Center in Prestonsburg, the Floyd County seat. "It's not health care reform.''