Kentuckians with pre-existing conditions had nothing to fear prior to Obamacare, Governor Matt Bevin recently told ABC13, because the state employed a high-risk pool that would cover the people cast aside by insurance companies.

But the Republican’s claim is misleading in more ways than one: yes, Kentucky provided such a program, called KY Access, but the “high-risk pool insurance only worked for a fraction of the people who needed it.”

“We used to have [protections for pre-existing conditions] before the [Affordable Care Act] existed,” Bevin said. “We had a high-risk insurance pool here in this state to help people in this exact same position — people that could not get coverage.”

Prior to the ACA, insurance companies routinely denied coverage to people with pre-existing conditions. KY Access offered a solution for some but not all people in the state who needed help.

The program ran for 13 years, and at its peak, only 4,837 people were enrolled. By comparison, nearly half a million people gained coverage when the state expanded Medicaid under the ACA, including those who were previously denied access due to pre-existing conditions.

“In hindsight they didn’t cover nearly as many people, they provided inferior benefits at a much higher cost,” Dustin Pugel with the Kentucky Center for Economic Policy said in 2017. “Going back would be a bad idea for half a million Kentuckians who are getting coverage right now [through the ACA].”

Beyond Kentucky, lack of coverage for people with pre-existing conditions was a problem across the entire U.S. before the ACA was implemented.

A 2009 Harvard University study found that as many as 45,000 Americans were dying each year due to lack of health insurance coverage.

The study “found that uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993.”

In fact, lack of health insurance was found to be associated with more deaths than common killers like kidney disease, the report stated.

Bevin’s assertion that individuals with pre-existing conditions were or would be well-served by a high-risk pool is not borne out by the evidence.