ASHLAND U.S. Sen. Rand Paul pitched his vision for American health care and debated it with local medical professionals Friday at King’s Daughters Medical Center, as the Senate prepares to receive the House GOP’s Affordable Care Act replacement bill.

Paul, a libertarian-leaning Republican, spoke at length about the financial burden of the current health care law on the federal government, and his belief the health care system should be more market-based. He said the expansion of Medicaid, which spurred the majority of new health insurance enrollees to get insurance, is not feasible.

“I call it the big-hearted, small-brain syndrome, which is very, very prevalent in Washington,” he said. “They (lawmakers) are sympathetic, they want to help people. We all do. But if you destroy the country helping people, would be better off or worse off?”

Kentucky was impacted immensely by the expansion of Medicaid. In the first two years of the ACA, about 420,000 Kentucky residents became insured through the expansion. The uninsured rate in the state dropped from about 20 percent to 7 percent.

King’s Daughters Chief Medical Officer Richard Ford said the rate of the hospital’s patients on Medicaid jumped from 17 percent to 23 percent since the passage of the ACA. He said the increase in insured patients is crucial to the future of King’s Daughters, and the smaller hospitals throughout eastern Kentucky.

“My problem with the Medicaid expansion is that it’s dishonest accounting,” said Paul. “We’re going to spend $500 million more than comes in this year. A couple years ago it was $1 trillion in one year. We’re now up to a $20 trillion debt.”

Medicare, Medicaid, Social Security and providing food stamps account for “two-thirds of the budget,” Paul said.

“We do not have enough money for the promises we made to all of those people. So when you say, ‘well gosh, what about the Medicaid expansion. Our hospital will do better, our community will do better.’ I’m not saying that it might not seem that way, but who’s going to pay for it?”

Paul said even if the federal government reverted back to paying only a portion, the state of Kentucky wouldn’t be able to foot the bill for Medicaid expansion.

“If we were to do 30-70, the way it’s always been, the governor’s told me and every legislator I’ve met, says there’s not enough money to pay for it, have to take money away from roads and schools and everything else they do in Frankfort,” said Paul. “It’s also the same in Washington.”

Dr. Garfield Grandison, a gastroenterologist, suggested to Paul he take into account more than cost when he and the rest of the Senate craft their health care bill. Grandison and a local social workers said they’re concerned patients suffering from mental health and substance abuse problems could be hurt by the ACA replacement.

The House bill reverses a provision in the ACA forcing states to order insurers to cover 10 “essential” health services in all plans, including mental health and substance abuse services. The worry among some health care professionals is patients who need those services won’t have the impetus to pay for them if they aren’t included in basic insurance plans.

“I want to make sure when you go back to Washington you understand there’s another side to this,” said Grandison. “When you remove the essential health benefits and make it all patients’ choice, there are consequences.”

“Yes,” Paul said. “The consequence will be if you remove the mandates, the cost will go down.”

“Yes,” Grandison said. “But I want you to consider what will happen if you remove certain protections under the current health care law.”

Paul said the fundamental question is based, for instance, on if a 72-year-old should be forced to pay for special procedures for others, such as pregnancy, in a free society.

“Should I be forced to drive on every single road my taxes pay for, or use every park my taxes help pay for?” said Grandison. “I understand from the standpoint of cost, where you’re going. You’ve made a good argument on cost, but there are other aspects that should be considered and part of the debate.”

Dr. Mohamad Abul-Khoudoud, a local pulmonologist, said he doesn’t understand why the U.S. can’t simply mirror other nations and adopt universal health care.

“We put a man on the moon, we are talking about going to Mars, we should figure out our health care system,” he said. “Why can’t we insure every American in this country from birth to the nursing home? We have billions of dollars to spend on walls, and wars. … To somebody who lives in a democracy, this is mind-boggling.”

Paul said a national, single-payer system would mean “dramatically raising taxes” on the working class. “I’m not sure society is going to take that,” he said.

Later in the discussion, Paul recapitulated the alternative to Obamacare he proposed in January, specifically the concept of legalizing “health insurance associations” to allow people who don’t get insurance from employers to pool together and lobby for lower premium rates and deductibles against insurance agencies.

National groups, such as AARP and the National Rifle Association, should be empowered to hire negotiators on behalf of members to try and lower health insurance prices, Paul said.

“If I’m a plumber and my wife and we have insurance, it’s the two of us, and I call a billion-dollar insurance company. Do they have any incentive to treat me with respect? No, I’m two people, they don’t care,” he told reporters after the event. “But what if I’m a member of the NRA, and there’s 5 million of us, and we buy our insurance through the NRA. Do you think they’re going to take the call from my representative of the NRA? Well yeah, because if they don’t please the customer they’re going to lose 5 million of us. Market leverage works better.”

Paul said he is working to implement the so-called health associations in the Senate bill. Insurance companies oppose the idea, and insurance CEOs he spoke to “hate” most of his health care proposals, he said.

A few hours before Paul spoke in Ashland, the non-partisan Congressional Budget Office, or CBO, in Washington announced it will release on Wednesday a score of the House GOP health care bill, also known as the American Health Care Act.

The GOP did not wait for the new CBO score before the bill was narrowly passed. A previous CBO report on the bill, before it was amended, estimated 24 million people could lose insurance by 2026.

Paul said he’s eager to learn of the new estimates insured, and the cost.

“For me, it is about trying to have a product that would be eligible for everyone in the individual market,” said Paul.

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Paul talks health care in Ashland, says Medicaid expansion too costly