As quickly as the situation is changing, who knows how much of this will apply as you read it? But the first three drafts no longer apply and the deadline is fast approaching.

The health insurance uninsured rate has dropped by some 13 million people since the Affordable Care Act (ACA) was passed. Some 11.4 percent of Kentuckians benefit from this law. The change from KYNECT to the new plan has raised the fear of many people dropping their coverage, though, and there seem to be big changes coming from the new Trump administration.

The Consumer Financial Protection Bureau conducted a study of people who had been contacted by a collection agency. The number one reason (59 perecent) was medical debt. Second was telecommunications (37 percent), followed by utilities (28 percent). Of these three reasons, only the medical debt was felt across all income levels, all ages and all credit scores. Even though more people have health coverage now, many still have a hard time paying for care. This is less a problem now than it was before the ACA.

The new administration has proposed converting Medicaid into a block grant program, where a specific amount of money will be given to each state. An advantage of a block grant is that the state can experiment with different ways of spending the money to achieve the goal. A disadvantage is the possibility of mixing grant funds with funds collected through taxes and unrestricted spending.

An insured public is more productive for many reasons. Among those reasons, folks can take jobs they enjoy and are good at rather than taking a job that offers health insurance. Very few farm families could stay in their profession if there wasn't someone in the family with a "public" job to provide insurance.

Hospitals get incentives to experiment with new procedures to improve care. Emergency rooms are now reimbursed at least a portion of their expenses for those who come in. And since emergency rooms cannot turn people away, the uninsured may go back to using the ER instead of regular doctor visits. And fewer people would be getting regular physical exams. Knowing your numbers, getting control of high blood pressure and high cholesterol, is far less expensive than dealing with the illnesses that can result from unknown but easily treated conditions.

The ACA is not perfect. But America is better off now than it was before the ACA. The confusion surrounding repeal and replace is making many Americans uneasy. Why not repair? Fix what's broken and leave the rest alone.

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