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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 3 hours ago - Politics & Policy

Shooting at Michigan high school leaves 3 dead, 8 wounded

Police cars restrict access to Oxford High School following the shooting in Oxford, Michigan, on Tuesday. Photo: Matthew Hatcher/Getty Images)

A 15-year-old sophomore was arrested after a shooting at a Michigan high school that left three people dead and eight others wounded Wednesday, according to the Oakland County Sheriff's Office.

The latest: Oakland County Sheriff Michael Bouchard said at a briefing Tuesday night that the suspect's father had on Friday bought the 9mm Sig Sauer pistol investigators believe was used in the shooting at Oxford High School. Authorities released the names of the victims late Tuesday.

City Council member Andre Dickens wins Atlanta mayoral race

Atlanta Mayor-elect Andre Dickens in Atlanta, Georgia, late Tuesday. Photo: Paras Griffin/Getty Images

City Council member Andre Dickens won a runoff election Tuesday to become Atlanta's next mayor, soundly beating the council's president Felicia Moore.

The big picture: Dickens was just a few months ago considered to have an outside chance of replacing Mayor Keisha Lance Bottoms, who announced in May that she wouldn't seek a second term.

UN report: Pandemic set to cost global tourism $2 trillion in 2021

A tourist in front of the Eiffel Tower in Paris on Nov. 25. Photo:Chesnot/Getty Images

A new United Nations report warns that global tourism will see only modest revenue gains in 2021 after last year's historic losses amid the COVID-19 pandemic.

Why it matters: Tourism revenues in 2020 fell by more than half from the previous year — a significant blow to the global economy, according to analysis by the UN World Tourism Organization (UNWTO).