"When I got pregnant, I didn't have insurance," said Alondra Toribio, 24, who has a 3-year-old son. "I was looking at a $600 visit for whenever I was pregnant."
For the single mother, now making just over $1,000 a month while working for a Head Start program, the expense of raising a child is overwhelming. Toribio, of Owensboro, said her current employer offers insurance, but the employee contribution would eat up more than half her take-home pay.
"If I were to get that insurance," she said, "I would only come home with like $100 a week."
Both she and her son have health insurance thanks to the Affordable Care Act's expansion of Medicaid benefits to millions of Americans who couldn't previously qualify.
"I was not wanting to be in debt," Toribio said of her decision to seek out Medicaid. "It weighed on my mind where I'm like, 'Alondra, you're always going to be owing somebody money,' you know."
Kentucky embraced the Affordable Care Act, expanding Medicaid, creating its own insurance exchange and mounting an aggressive campaign to educate and enroll its population. Since then, Republican Gov. Matt Bevin ended new signups to the exchange. Still, the results are noteworthy, particularly in a state that supported Donald Trump by 30 points over Hillary Clinton.
Today, more than 1.3 million Kentuckians are on Medicaid, and about one-third -- 440,000 -- are covered thanks to its expansion. Between 2013 and 2015, Kentucky's rate of uninsured fell from nearly 15% of the population to 6.5%. Nationwide, that's among the sharpest declines of those living without insurance.
Paula Murphy was one of them. Never in her life had the 63-year-old hairdresser had insurance.
"I have high blood pressure, diabetes, and my cholesterol is high," added Murphy, also of Owensboro, with a laugh. "I guess I hit the trifecta."
But when it comes to the insurance she has now through the Affordable Care Act, her eyes narrow.
"I'm scared," she said. "I feel like if I lose my health insurance, my quality of life will be seriously affected, and I can't see a good outcome."
Murphy speaks knowingly. "Twenty-eight years ago, I broke my back in two places," she said, recalling the pain of injury followed by debt. "I had no insurance, paid that hospital bill off over several years."
Murphy, who otherwise might be considering retirement, says she's able to pay $100 a month for insurance, but anything higher would be a financial impossibility.
She's quick to point out that she did not vote for Trump. She was shocked when she woke up to learn that he had won the election, she said.
But of Trump's campaign promise to replace Obamacare with something better, she said, "If he shows me a concrete plan that I can afford, I'm all for it."