Paul Ray's father died from colon cancer in 2008. He was 63 years old and refused to have a colonoscopy, telling his son that area of his anatomy was "an exit only."
"The next thing you know he got sick and had to have it checked. By then it was too late," Ray said.
Ray, 50, is a lot like his father. He looks after 5,000 hogs on a farm in Calhoun, Kentucky, and he doesn't like doctors. But one day while accompanying his wife to an appointment at the hospital 30 minutes from his home, he spotted an inflatable colon in the lobby, part of an outreach campaign. His wife told him he needed to check it out.
He did. And because Ray is one of the more than 400,000 adults who have Medicaid because of the federal Affordable Care Act, his screening and subsequent colonoscopy were covered. Doctors found a polyp โ a clump of cells on the lining of the colon that can develop into cancer โ and removed it.
"Without (Medicaid), I mean, I couldn't afford it," Ray said. "Have you seen what a doctor charges?"
While Kentucky's expanded Medicaid program brought coverage to hundreds of thousands of people, a new study from the University of Kentucky shows one way they have used that coverage: colon cancer screenings. The study found the number of Medicaid patients in Kentucky to be screened for colon cancer increased by 230 percent after the expansion.
That's a significant increase for a state that has the highest rate of colon cancer incidence in the country, according to the Centers for Disease Control and Prevention. While more Kentucky Medicaid patients were diagnosed with colon cancer after the expansion โ a 132.4 percent increase โ researchers found more of them survived. This was especially true in eastern Kentucky, where Medicaid coverage of Appalachian patients increased by 199 percent.
"The Medicaid expansion allowed us to get access to a lot of near-poor patients that would have otherwise not been able to get screened," said lead study author Avinash Bhakta, a colorectal surgeon at the University of Kentucky Markey Cancer Center.
Republican Gov. Matt Bevin has called the Affordable Care Act "a mess" and has said it is financially unsustainable. Carol Steckel, Bevin's Medicaid Commissioner, said while the study from the University of Kentucky suggests expanded Medicaid eligibility increased cancer screenings and incidence and survival rates, "the design and descriptive methodology of the study cannot establish that the Affordable Care Act caused these benefits."
"Medicaid is a critical component of caring for individuals experiencing cancer; however just having a Medicaid card is only a small part of the needed cancer solutions," she said.
Steckel said the Cabinet for Health and Family Services has a "wide ranging strategy" to combat cancer, which includes increased access to genetic testing and more investment in the state's Pediatric Cancer Research Trust Fund.
A University of Kentucky spokesman declined to respond to Steckel's comments.
The study comes at a time of uncertainty for Kentucky's Medicaid program. Kentucky is one of 36 states to expand its Medicaid population under the Affordable Care Act.
Since then, Bevin has been trying to overhaul the program. He wants to charge some Medicaid recipients small monthly premiums. And he wants them to have a job, go to school, or volunteer to keep their benefits, with some exceptions.
State officials estimate the Medicaid population will decrease by at least 98,000 people over five years. Some advocacy groups say that's a conservative estimate.
Last month, a federal judge blocked the new rules from taking effect. Bevin has said the state will appeal the ruling. Bevin has vowed if his proposed changes are ultimately struck down in court, he would eliminate the expanded Medicaid program altogether.
While Ray's colon is clear, he said doctors have identified potential cancers in his kidney and his small intestine. He's waiting for test results.
Some health care advocates say Bevin's proposed changes would make it harder for poor people to access the program. But Ray, who said he voted for Donald Trump, doesn't see it that way. He said he supports Bevin's proposals, adding it would have been easy for him to live on disability payments for the rest of his life because of a back injury. He rejected that route and got a job โ something he said he has done since he was 8 years old and packing tobacco sticks.
"Whatever had to be done," he said. "I get up every day and go to work."