Jeff Fletcher claps his hands after Courtney Lively tells him he will get insurance. The 52 year old disabled master electrician had been ignoring a spot on his lung that was discovered during a visit to the emergency room after he broke some ribs several years ago.

[imgcontainer] [img:healthcareKY.jpg] [source]Photo by Luke Sharrett / For The Washington Post[/source] Jeff Fletcher claps his hands after Courtney Lively tells him he will get insurance. The 52-year-old disabled master electrician had been ignoring a spot on his lung that was discovered during a visit to the emergency room after he broke some ribs several years ago. [/imgcontainer]

The Washington Post looks at the implementation of the health-insurance marketplace in Kentucky.

Bucking the trend of its neighboring Southeastern states, Kentucky opted to create its own marketplace, rather than use the federal system (you know – the one with all the website problems?). The state also accepted federal funds to expand Medicaid to residents who don’t make enough to qualify for government subsidies for private health insurance.

And while the nation bickers about Obamacare, reports Stephanie McCrummen, Kentucky is quietly getting people signed up for health insurance programs. McCrummen writes with a dateline in rural Breathitt County in eastern Kentucky:

This is how things are going in Kentucky: As conservatives argued that the new health-care law will wreck the economy, as liberals argued it will save billions, as many Americans raged at losing old health plans and some analysts warned that a disproportionate influx of the sick and the poor could wreck the new health-care model, [Courtney] Lively was telling [Woodrow Wilson] Noble something he did not expect to hear.

“All right,” she said. “We’ve got you eligible for Medicaid.”

Places such as Breathitt County, in the Appalachian foothills of eastern Kentucky, are driving the state’s relatively high enrollment figures, which are helping to drive national enrollment figures as the federal health exchange has floundered. In a state where 15 percent of the population, about 640,000 people, are uninsured, 56,422 have signed up for new health-care coverage, with 45,622 of them enrolled in Medicaid and the rest in private health plans, according to figures released by the governor’s office Friday.

If the health-care law is having a troubled rollout across the country, Kentucky — and Breathitt County in particular — shows what can happen in a place where things are working as the law’s supporters envisioned.

Rural Hearing. The House Oversight and Government Reform Committee is holding a field hearing today entitled “Obamacare Implementation: High Costs, Few Choices for Rural America.” The hearing was scheduled to start this morning in Gainesville, Georgia.

Something to Smile About. A new type dental practitioner – similar to a physician’s assistant in medicine – could help deliver dental care in underserved rural areas, writes Larry Dreiling in the High Plains/Midwest Ag Journal.

The Registered Dental Practitioner program is an emerging effort nationwide designed as a mid-level provider, similar to a physician’s assistant, that will increase access to dental care.

Under this model, registered dental hygienists can complete additional education and training to become RDPs. With the supervision of a dentist, the RDP is able to provide preventive care, cleanings, extractions and fillings.

Alaska and Minnesota are already experimenting with the new system.

And Something to Frown About. The farm bill negotiation is stalled. The reconciliation committee in charge of patching together legislation from the House and Senate versions of the bill failed to reach an agreement last week. If there’s no movement on the bill by January, dairy programs would be the first to be affected by the lapse, reports the Wall Street Journal.

The nation’s agriculture, rural development and major natural resource policy is currently operating off an extension of the farm bill enacted in September. That’s the second extension Congress enacted on the current legislation. The last new farm bill Congress passed in 2008.

If Congress does not keep the farm bill current, ag programs revert to the 1949 Agricultural Act.

Broadband Becomes Gubernatorial Issue. Broadband access is an issue in Iowa’s 2014 gubernatorial race, report Nate Robson in the Sioux City Journal.  Incumbent Republican Terry Brandstad has touted Connect Every Iowan, an initiative to expand access and formed a broadband committee that will make recommendations for improvement next week. Democratic candidates have said those efforts are insufficient.

Iowa ranks 34th in the nation for high-speed access and is last compared to its neighboring seven states, Robson reports.

Rural school districts say the lack of bandwidth is keeping students from going online. “If you can’t get everyone online, it really limits what they can accomplish in school,” said one parent. “I think kids now use the Internet more than the library.”

A War on Corn? Iowa Gov. Terry Brandstad says the Environmental Protection Agency’s scaling back of the renewable fuel standard amounts to a “war on corn.” The debate over the standards – which cover how much ethanol must be blended into gasoline – is shaping up to be a cross-cutting issue, reports the Iowa Gazette:

The debate cuts across political lines. Biofuels have found support among Republicans and Democrats from agriculture states, including Iowa, Minnesota and Illinois.

But biofuels are opposed by powerful interests, too. The oil industry is one, but opposition has sprung up from some environmental groups as well as livestock organizations that say the Renewable Fuel Standard keeps the price of feed artificially high.

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