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Kentucky's health care microcosm

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.
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