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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

Dion Rabouin, author of Markets
38 mins ago - Economy & Business

The Fed could be firing up economic stimulus in disguise

Federal Reserve governor Lael Brainard at a "Fed Listens" event. Photo: Eric Baradat / AFP via Getty Images.

Even as global growth expectations increase and governments pile on fiscal spending measures central bankers are quietly restarting recession-era bond-buying programs.

Driving the news: Comments Tuesday from Fed governor Lael Brainard suggest the Fed may be jumping onboard the global monetary policy rethink and restarting a program used following the 2008 global financial crisis.

Democrats' hypocrisy moment

Illustration: Eniola Odetunde/Axios. Photo: Ray Tamarra/Getty Images

Gov. Andrew Cuomo should be facing explicit calls to resign from President Biden on down, if you apply the standard that Democrats set for similar allegations against Republicans. And it's not a close call.

Why it matters: The #MeToo moment saw men in power run out of town for exploiting young women. Democrats led the charge. So the silence of so many of them seems more strange — and unacceptable by their own standards — by the hour.

Police officers' immunity from lawsuits is getting a fresh look

Illustration: Aïda Amer/Axios

Nearly a year after the death of George Floyd, advocates of changes in police practices are launching new moves to limit or eliminate legal liability protections for officers accused of excessive force.

Why it matters: Revising or eliminating qualified immunity — the shield police officers have now — could force officers accused of excessive force to personally face civil penalties in addition to their departments. But such a change could intensify a nationwide police officer shortage, critics say.