Ted Strickland joked a few weeks back that there used to be a time when Republicans and Democrats debated the issues of the day. Those were the good days, when facts still mattered. Now, with the new breed of modern Republicans in denial about so many things, the former Ohio governor and congressman said it’s come down to debating reality.

Reality In Cleveland

The reality the GOP can’t handle is just how well the Patient Protection and Affordable Care Act has converted a terribly broken healthcare delivery system, that had it not been checked would have driven the nation off the fiscal cliff sooner rather than later, into a system that delivers across the board. From individuals and families to small and big business, benefits of the bill are in plain sight for anyone with eyes wide open.

Case in point, Ohio’s pride and joy in the medical field is the Cleveland Clinic, a powerful medical Titan with its own zip code. Republicans will be picking their president in 2016 in Cleveland, so they might be interested in learning from the city’s world-recognized medical complex, which happens to be one of the largest hospitals in the country, how it’s doing under the ACA. Under the old broken healthcare delivery system the ACA replaced in 2010, the number of people without health coverage ballooned up to about 50 million, who due to high costs, accessibility or pre-existing conditions, lived on the edge, hoping to not get sick. But when they did, expensive emergency rooms often served as a sick patient’s first visit to the doctor. With 16 million or more people gaining coverage from the ACA, now that it’s in full operating mode, there are cost savings being experience by major players, including like the Cleveland Clinic. Costs are declining and future performance will be even better, especially if Republicans stop trying to monkeywrench it or repeal it.

Down 40% In One Year

All that charity care hospitals used to pay for because patients without coverage didn’t have money to pay the always high emergency room bills or hospital stays for admitted patients, just got a little smaller—by 40 percent in one year, according to the Cleveland Clinic which just reported it reduced its charity care spending, defined as the cost of free care provided to patients who can’t afford to pay. From $171 million in 2013 to $101 million in 2014 should be impressive, even for deniers of the ACA and its capabilities.

Cleveland Clinic officials credited the expansion of Medicaid—made possible by Obamacare—for the improvement. “The decrease in charity care is primarily attributable to the increase in Medicaid patients due to the expansion of Medicaid eligibility in the State of Ohio and the resulting decrease in the number of charity patients,” the hospital’s year-end financial statement reported, according to Kaiser Health News.

John Palmer, spokesperson for Ohio Hospital Association, said the 40 percent drop spotlights a trend in how payments are changing for all providers since the health law rolled out the expansion of Medicaid—increasing eligibility to 138 percent of the federal poverty level—and for the subsidies that make previously unaffordable insurance now affordable to lower-income people who purchase policies on the new insurance marketplaces.

“Now that you’re starting to see that shift from uninsured or underserved on over into health care programs such as Medicaid and the exchange, that has had a good impact,” Palmer said. “And, obviously, it is reflective of what hospitals are experiencing with uncompensated care in the areas of charity care especially.” Adding to the good news, last week federal sources said the number of uninsured and self-pay patients is down substantially, especially in Medicaid expansion states including Ohio. Uncompensated care costs—including charity care and bad debt—tumbled as people now had healthcare insurance. KHN said for states taking advantage of the ACA over those who didn’t, there’s a tidy estimated sum of difference between them of about $2.6 billion in additional savings by the 28 that didn’t fight the ACA.

Ohio is one of 28 states and the District of Columbia to expand Medicaid under the federal health law. Nearly one-half million Ohio residents have so far enrolled through the expansion. An additional 234,341 residents were selected or automatically re-enrolled in a private plan on the state’s federally run exchange.

On the business side of the hospital, the ACA is directly contributing to the boost in revenues to hospitals including the Cleveland Clinic. Not only has total uncompensated care fell 27 percent to $211 million in 2014, but revenue is up significantly. Operating income is now $466, an increase of 60 percent, and total revenues are $6.7 billion. Other factors for the good numbers included cuts in energy use, employee health insurance costs and staff.