 Paul calls for the eventual elimination of Medicare (federally funded health care for the elderly and disabled) and Medicaid (health care for the poor, jointly funded by the federal and state governments), and he has been a staunch opponent of the Affordable Care Act health insurance reform law that was enacted in 2010.He says that federally funded healthcare is "unconstitutional" and that the costs of the programs are unsustainable and are bankrupting the government.Paul says that when he entered medical practice in the early 1960s, before the Medicare and Medicaid programs were established, the poor and the elderly were hospitalized at about the same rates as they have been under Medicare and Medicaid in the 2000s, and that they received good care.