Despite a rise in the number of insured residents, Obamacare getting mixed reviews in Eastern Ky.

When federal health reform was introduced last year in Eastern Kentucky—a largely Republican area that has for years relied on the coal industry—Central Appalachia residents were skeptical of President Obama's health care system.

The jury is still out whether or not locals are calling the plan a success, Laura Ungar and Chris Kenning report for USA Today. Obamacare "has given many of the poor and sick a key to long-neglected health care. It's also brought skepticism and fear, and some business owners argue it's stunting their growth in a region that can't afford another economic blow."

On the plus side, "scores of newly insured residents, mostly covered by Medicaid, have sought care in hospitals, mental health centers and drug treatment facilities," Ungar and Kenning write. In places like Floyd County—which ranks second to last in the state's health rankings because of high rates of smoking, cancer, diabetes, obesity and heart disease—the uninsured rate of residents under 65 dropped from 19 percent to 10 percent by the end of 2014. (Family Search map: Floyd County)

"Overall, 5,403 Floyd County residents have enrolled in Medicaid under the ACA, while only 620 have bought private health plans on the state's 'kynect' exchange," Ungar and Kenning write. "Data from a recent state examination of the Medicaid expansion found it had brought $15.5 million in Medicaid payments to Floyd County in 2014, including $5.9 million to hospitals."

But many Floyd County residents echo the same complaints as in other parts of the state, "such as the tax penalty people must pay if they don't have insurance and the upcoming requirement that businesses with more than 50 full-time employees provide affordable insurance or face a penalty," Ungar and Kenning write. "Hospitals report being squeezed financially. One insurance agent says the system remains difficult to navigate. Many who don't qualify for Medicaid or a sizable subsidy—and have been largely left out of the health care system—say their insurance has gotten more difficult to afford."

One insurance agent said "some residents who purchased private plans on the state exchange in 2014 found the monthly premiums rose sharply in 2015, causing some to drop out or reduce coverage," Ungar and Kenning write. Other residents who are waiting for their employers to provide health insurance could be waiting a long time.

"Archie Everage, who owns a chain of fast-food sandwich shops in Floyd and nearby counties that employ more than 80 full- and part-time workers, said he plans to pay a fine of $2,000 per full-time employee rather than provide insurance as the ACA requires," Ungar and Kenning write. "Paul Reffett, owner of ValueMed pharmacy, said the ACA has meant more work but less profits," with more customers getting prescriptions but paying with Medicaid instead of cash, "meaning low reimbursements instead of full payments."

Hospitals also say that with Medicaid handled by managed-care companies, reimbursements are slow in coming, Ungar and Kenning write. And more Medicaid patients means more slow payments. (Read more)