- Associated Press - Friday, May 19, 2017

ASHLAND, Ky. (AP) - Before Barack Obama’s health care law, about 17 percent of patients in the King’s Daughters Health System were paid for by the government-run Medicaid program. Today, after the law added 400,000 people to Kentucky’s rolls, Medicaid pays for 23 percent of patients at the hospital system on the Kentucky-Ohio border.

“It would be the difference between staying open and not staying open,” said Richard Ford, King’s Daughters chief medical officer.

Yet Ford and other doctors at the King’s Daughters Medical Center in Ashland did not get much assurance from U.S. Sen. Rand Paul about Medicaid’s future on Friday as he met with them to discuss the prospects of a Republican-backed bill to repeal and replace Obama’s law. The nonpartisan Congressional Budget Office noted a previous Republican plan would have left 24 million people without health insurance, many of them Medicaid beneficiaries. Estimates for the latest Republican bill, which passed the House last week, are scheduled to be released next week.

Paul, an eye surgeon, told the crowd of medical professionals that the law’s rapid expansion of the government-funded health insurance program could not continue.

“We don’t have any money; we have a printing press,” Paul said. “And we borrow $500 billion a year. And there is the question: Could we ultimately destroy the country with that much debt? I call it the big-hearted, small-brain syndrome, which is very, very prevalent in Washington. They are sympathetic, they want to help people. We all do. But the thing is, if you destroy the country helping people, would you be better off or worse off?”

Kentucky has been one of the most impacted states in the country from Obama’s health care law. The state’s uninsured rate fell from 20 percent to 7.5 percent in just two years, among the largest coverage gains in the country. At the King’s Daughters Health System, the number of uninsured patients after the law was implemented fell to 2 percent from 11 percent. But despite the hospital’s dependence on Medicaid, the amount of money the hospital made from each of those newly insured patients fell, too. Ford says the system struggles to make a profit.

“It was more of a redistribution from one patient to the next more than it was helping us with covering our own expenses,” Ford said.

Paul’s solution to fix all of this is to make the health care system more market-based. He wants to make it legal for people who don’t get health insurance from their employer to join together with others in nationwide “health associations” to increase their bargaining power. Imagine, he said, if the NRA’s more than 5 million members were able to join forces and negotiate with health insurance companies as a group instead of individually.

“If I’m a plumber and my wife, and we have insurance the two of us, and I call a billion dollar insurance company, do they have any incentive to treat me with respect? I’m two people, they don’t care,” Paul said. “But what if I’m a member of the NRA (National Rifle Association) and there is 5 million of us and we buy our insurance through the NRA, do you think they’re going to take the call?”

Paul said he is working to get his health association idea into the Senate bill, but noted the insurance industry opposes it. He said it would also be a challenge to overcome some of the Senate’s rules against extraneous amendments.

“I think people are in favor of it,” he said.

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