President Obama Speaks On The Government Shutdown In The Rose GardenThe Affordable Care Act’s Kentucky successes and failures are highlighted in a new, lengthy New York Times feature.

The article, published Dec. 29, is titled “Success of Kentucky’s Health Plan Comes With New Obstacles” and was written by Amy Goodnough.

It’s an informative, if somewhat depressing, read. Here’s how it starts: “In many ways, Kentucky, a poor state with a starkly unhealthy populace, has become a symbol of the Affordable Care Act’s potential.”

One takeaway is that many of the state’s poorest have flocked to the ACA, aka Obamacare, through the state’s expansion of Medicaid, leading to a steep decline in the uninsured.

“Hospital revenues are up, health care jobs are multiplying and far more Kentuckians are getting preventive checkups and screenings, according to state officials,” Goodnough writes.

She spends a lot of the article tracking the health care progress of a woman named Amanda Mayhew. Mayhew enrolled in Medicaid last August, and it has vastly improved her life. She’s seen the dentist five times as she’d neglected her teeth, had a mole removed, and has gotten anti-depression meds, all without paying a dime.

Yet Mayhew is still ambivalent about the ACA.

Here’s how Goodnough put it:

“‘I don’t love Obamacare,’ she (Mayhew) said. ‘There are things in it that scare me and that I don’t agree with.’”

For example, she said, she heard from news programs that the Affordable Care Act prohibited lifesaving care for elderly people with cancer.

There is no such provision, although a proposal to pay doctors to engage patients in end-of-life planning — such as whether they would want life-sustaining treatment if they were terminally ill — was removed from the law after it sparked a political firestorm over ‘death panels.’”

The article also makes the point that such misinformation remains widespread, meaning the ACA’s proponents still have an uphill battle when it comes to informing the public.

Another problem with the ACA in Kentucky, the article says, is that while tons of low- or no-income folks have taken advantage of the Medicaid expansion, far fewer have signed up for the actual health care plans available:

“People earning between 138 and 400 percent of the poverty level — between about $16,000 and $47,000 for a single person — can get subsidies to help with the cost. Even with that incentive, only about 76,000 Kentuckians signed up for these plans in 2014 and have renewed the coverage for next year.”

The reason? People still find these plans too expensive, even with the subsidies.

The story also tracked the progress of a Kentucky man named David Elson, who had failing kidneys and high blood pressure, but earned too much money to go on Medicaid, as he made $28,000 a year.

He was averse to paying the premiums demanded of the plans, but ultimately realized it was either that or die. He reluctantly agreed to all the medical help he would need, including surgery at the University of Louisville hospital (described as a “safety net hospital that treats the city’s uninsured”), and agreed to daily dialysis, even though he was worried he wouldn’t be able to work and that no one would be available to feed his cat.

And for all his resistance to getting help, when he finally followed through on the program, it improved the quality of his health:

“He has lost 70 pounds of water weight and appears re-energized. He has become more careful about what he eats, he said, and his blood sugars have dropped. He can sleep soundly again, with no pain waking him overnight.

Hooked up to the machine one recent morning, Mr. Elson pulled his new Medicare card out of his shirt pocket and held it to the light before carefully tucking it back inside.

‘I finally got insurance,’ he said. ‘What a way to get it.’”

To judge by this article, the ACA still remains a bit of a paradox. Lots of people have signed up for it, yet not all that many people with some means, who would be able to pay for the health care they receive. At the same time, some of those who do use it may not be informed about what the ACA is really all about.