Kentucky: A Republican Responds.

A couple of days ago, in response to my debunking of Mitch McConnell's litany of lies about the Affordable Care Act, I posted a letter from a Kentucky resident who gave his view of the situation.

In response to that, another Kentucky resident responded with a different perspective. Again, aside from cleaning up some typos and breaking it into more paragraphs for easier readability, I'm presenting it verbatim:

Mr. Gaba, I am also from Kentucky. I appeciate your fact checking of McConnell on the ACA and in most instances I would say that you are correct and he is not.

That said, I work in health care and we have also seen a boon in our bottom line due to decreased uncompensated care and bad debts. We are also in a poor county and almost 80% of the people were Medicaid recipients including some of my family members, so the ACA, at least in the short term has benefited us.

I think that it truly depends on your hospital demographic as to whether you benefit under the ACA, but that is not my biggest concern. What happens in 3 years when my state and all the other states that expanded Medicaid have to pay for it?

You see, we all forget that someone MUST pay the bill at some point and most people probably think it will not even be in their lifetime, so why worry? Please do not misunderstand; the system needed reform and the Republicans, of which I am one, obviously have no clue what really needs to be done, but this ACA is not what all liberals and democrats think it is.

Someone will pay, and eventually it will be hospitals and access will decrease. Thanks for listening.

I responded to him by noting that taxpayers were already paying for healthcare for the poor in the form of insanely expensive ER care/etc, that the "woodworker" enrollees qualify for Medicaid regardless of the ACA, and that the cost to KY is phased in slowly over a 9 year period (0% for 3 years, 10% for another 6).

He followed up:

With regard to the first point, yes we were already paying and still are. Being a not-for-profit, we had a charity program internally and also had the state DSH program.  The Medicaid recipients were once "free" patients and even though our internal program covered our physicians so most did not have to pay, they still came to the emergency room.  Now that they have Medicaid, they still come to the ER.

We have a physician practice that must take Medicaid, but our pediatricians are not owned by hospital so they do not have to do anything.  Here is my experience: The physicians do not take Medicaid or the ones who do limit the number of Medicaid patients that they will see in a day.  If you're sick, you can't wait a week to get into the doctor, so you come to the ER.  Physicians need to be treated the same as any other provider and be told that they will be excluded from programs if they do not see these patients.  The cost of all these issues ultimately falls on the hospitals.

With regard to my concerns of the cost and them being dramatic, we are talking about big money and a small percent of big is still a lot, especially for some states that are already struggling with other debt.

Again, I am all for a change in the health care system but I have been in it for 25 years; when the piper needs to be paid, he needs to be paid and it is my concern that the hospitals will bear the brunt of that because somehow we are the greedy people who make way to much money and it seems that no one thinks ill of other doctors or health care professionals.

I must say thank you for listening, responding and yourself being intelligent and thoughtful for you thoughts. It is extremely welcome to have an honest, non-emotional discussion with someone.  In my business that does not happen often.