Expand chart
Data: U.S. Census Bureau Small Area Health Insurance Estimates; Map: Lazaro Gamio / Axios

After becoming the first state in the country to impose work requirements on Medicaid benefits, Kentucky remains a microcosm of all the biggest health care debates of the past decade.

The bottom line: There are states like California and Maryland that are always on the liberal leading edge, and states like Texas and Alabama that are consistently on the flip side of the coin, but only one state can claim to have been at the leading edge of both Obama’s and Trump’s health care agendas. So if you want to compare the two, look no further than the Bluegrass State.

  • Supporters of the Affordable Care Act were especially proud of the law’s results in Kentucky, where the uninsured rate plummeted, thanks in large part to a Democratic governor accepting the law’s Medicaid expansion.
  • Medicaid enrollment in the state increased by more than 100% since the expansion took effect.
  • Kentucky also decided, initially, to build its own ACA exchange, which ended up being one of the only functional marketplaces amid the turmoil of the HealthCare.gov launch.

But times change. Democrats were so happy about Kentucky, in part, because it helped them make the case that even the deepest red states could benefit from the ACA, and from Medicaid expansion in particular, if they’d just lean into it.

  • On Friday, though, Kentucky became the first state to win federal approval to impose work requirements within its Medicaid program. The state will require most adults who are not disabled to perform 80 hours per month of “community engagement,” which could include work or community service.
  • Gov. Matt Bevin’s administration has said the change could cause roughly 100,000 people to lose their Medicaid coverage.
  • Bevin previously turned the state’s exchange over to the federal government.

Go deeper

Updated 33 mins ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 3 a.m. ET: 31,032,045 — Total deaths: 960,729— Total recoveries: 21,255,717Map.
  2. U.S.: Total confirmed cases as of 3 a.m. ET: 6,805,342 — Total deaths: 199,511 — Total recoveries: 2,590,671 — Total tests: 95,108,559Map.
  3. Politics: Testing czar on Trump's CDC contradictions: "Everybody is right" Ex-FDA chief: Career scientists won't be "easily cowed" by political vaccine pressure.
  4. Education: What we overlooked in the switch to remote learning.
  5. Health: The dwindling chances of eliminating COVID-19 — 7 states set single-day coronavirus case records last week.
  6. World: England sets £10,000 fine for breaking self-isolation rules — The countries painting their pandemic recoveries green.
Updated 53 mins ago - Politics & Policy

Biden raises $141 million more than Trump

Combination images of President Trump and his 2020 presidential rival Joe Biden. Photo: Sarah Silbiger/Getty Images/Alex Wong/Getty Images

Joe Biden's campaign, the Democratic National Committee and joint fundraising committees raised $466 million cash on hand, the presidential candidate's team announced late Sunday.

Why it matters: President Trump's campaign raised $325 million cash on hand, his campaign communications director Tim Murtaugh announced Friday. In the spring, Biden was $187 million behind Trump and the Republican National Committee.

Virtual Emmys address chaotic year for American TV and society

Emmy Host Jimmy Kimmel during rehearsals Friday for the 72nd Annual Emmy Awards at the Staples Center in Los Angeles. Photo: Al Seib/ Los Angeles Times via Getty Images

The Emmy Awards Sunday night addressed the major U.S. issues this year — including the protests on systemic racism and police brutality, the wildfires engulfing parts of the West Coast, the census, the pandemic, essential works and the election.

Why it matters: Award shows have always addressed wider cultural issues, but this year — amid unprecedented stress and uncertainty — that trend has accelerated.