Kentucky the first state to fulfill Trump’s vision of a nation of uninsured poor people

[ Originally published on this site as post ]

Remember when Kentucky was the big success story, along with Arkansas, in healthcare? When it was leading the nation in reducing the number of uninsured people? Well, thanks to the Republican takeover of the governorship there and the White House, that’s all over now. So’s the $820 million the state was expected to save by 2021 in reducing the number of uninsured and making full use of the Medicaid expansion funds available to it.

On Friday, Kentucky’s Republican governor Matt Bevin was granted a waiver by Trump’s Department Health and Human Services, allowing him to impose new work requirements on people receiving or applying for Medicaid in his state.

Bevin’s proposal would require some adults to work or volunteer at least 20 hours a week to keep health benefits, saying it will inject more personal responsibility into the government health plan and believes participants should have some “skin in the game.” […]

In addition to work or volunteer requirements, Bevin’s plan includes copayments and premiums from many participants. People who don’t comply with rules could lose coverage and be “locked out” for months. […]

Bevin’s work requirement is aimed largely at “able-bodied” adults added to Medicaid under the Affordable Care Act and would exclude the elderly, disabled, medically frail or some caring for children or other relatives. The letter released Thursday by CMS authorizing work requirements contains similar language.

Despite those exclusions, the state expects as many as 95,000 Kentuckians to lose health coverage. That’s people dropping out of coverage. Tens of thousands more won’t ever apply for it because of the barriers it constructs. That will reverse all the gains the state made in the past four years, and then some.

This is just the first of 10 states which have applied for the waiver to get it. Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin have all applied and several others have expressed interest. Now that the waiver is official, expect law suits. Jane Perkins, legal director for the National Health Law Program, a patient advocacy group, says “We believe that the work requirement is indeed a problem because it is not consistent with Medicaid’s objectives.” That’s the basis—the Medicaid statute—the Obama administration used to refuse to grant these waivers.