Stephanie McCrummen, The Washington Post: Life After Jan. 1: Kentucky Clinic Offers Early Glimpse at Realities of Health-Care Law

“When they designed this law, it was Mary Blair they had in mind,” he said before he walked in, and then: “How are you doing, Mary? Everything’s been going okay?”

The 42-year-old had lost her job and her health insurance at 34, had a heart attack at 39, had six stents put into her heart and two in her leg, and had more than $30,000 in medical bills she was paying off in $20 increments, money from her husband’s part-time job at Advance Auto Parts.

“Been doing good,” said Blair, who was recently found to have diabetes and high blood pressure. She had a hacking cough.

“Has your blood sugar bottomed out any?” Hamilton asked.

“No, it’s good,” Blair said. “I just got the shakes real bad.”

“Your blood pressure is sky-high,” Hamilton said, starting his exam. “. . . Say, ‘Ah.’ ”

If it was a relief for Blair to finally have insurance, it was a relief for Hamilton, too, who grew up in Breathitt and worried often about fragile patients like Blair who were so often neighbors, old classmates, former teachers or distant relatives in the close-knit county. He was used to answering late-night calls from patients panicked over chest pains but afraid to go to the emergency room lest they incur thousands of dollars in bills and wind up with their name published in the newspaper, which is how the local for-profit hospital went about collecting bills.

“I’m always hearing, ‘I don’t want to get my name in that paper,’ ” he said.

On this day, though, he was slightly less worried, because Blair had insurance. He ordered a chest X-ray, prescribed medicine for the cough and adjusted one of her 13 prescriptions, pills that ran her about $100 a month before Jan. 1 but were about $2 each now.

“She will ultimately have bypass surgery done on her heart,” said Hamilton, who has turned down lucrative offers to practice elsewhere and who once considered volunteering in Haiti after the earthquake there until he decided that Breathitt County was almost as desperate. “It’s about as close to a mission field as you can get,” he said.

The ACA is already having a meaningful impact on the lives of poor Americans who never had insurance before. Thank you, Mr. President, and everyone else who fought to get this law enacted and implemented.