Republican Gov. Matt Bevin of Kentucky has requested that President Donald Trump allow him to fast-track work requirements for Medicaid in his state. Bevin campaigned on a platform to overhaul the Bluegrass State's Medicaid program, which he asserted was fiscally unsustainable despite being one of the biggest success stories of the Affordable Care Act, commonly called "Obamacare."
In 2013, former Democratic Gov. Steve Beshear of Kentucky expanded Medicaid in his state under the ACA. In that year, Kentucky's uninsured rate was at roughly 20 percent; by 2016, that figure had dropped to under 8 percent.
The several reforms to Medicaid proposed by Bevin would require able-bodied individuals aged 19 and older to work or volunteer for up to 20 hours a week in order to receive coverage, as well as charge all Medicaid recipients a premium of up to $15 a month. If beneficiaries cannot pay the premium, they would be shut out of the program for six months or receive fewer benefits.
Another change would require Medicaid recipients to immediately alert the state to any changes in their employment or salary. Failure to do so would also result in being locked out of Medicaid for six months.
The overhaul originally proposed phasing in work requirements. Able-bodied adults would be begin working five hours a week in order to receive Medicaid and gradually work up to the 20-hour requirement after 12 months.
On July 3, Bevin amended the proposal to cut out the grace period, meaning that the maximum work requirements would kick in immediately for Medicaid recipients. The Trump administration's Department of Human Health and Services is expected to grant a waiver for the amendment, The Hill reports.
Bevin's proposed changes have been hotly debated in Kentucky. The Kentucky governor has asserted that the changes would motivate Medicaid recipients to find employment with health benefits and save the state up to $2.4 billion by 2021.
On Jan. 7, Beshear accused his successor of simply trying to undermine the purpose of Medicaid.
"My biggest concern is that the efforts to get a waiver are really just disguise for, 'we'd like to kick as many people off this program as we can,'" Beshear told PBS.
"It is sustainable and it's affordable," Beshear said of Kentucky's Medicaid program. "But, you know, when you get into ideology... it's sort of, 'don't let the facts get in your way.'"
Some Medicaid recipients in Kentucky have balked at Bevin's proposed work requirements, especially those residing in rural areas.
"Around here, there ain't no jobs," 55-year-old Johnny Puckett of Magoffin County told Politico.
Economics professor James Ziliak of the University of Kentucky noted that Bevin's work requirements presume that there are job opportunities across the state.
"And they're not in in Eastern Kentucky," Ziliak said. "They're just not there."
Other critics of the Medicaid overhaul argued that many of those already working don't receive insurance benefits from their employer. Kentucky Equal Justice Center director Richard Seckel voiced concern that the new requirements would confuse beneficiaries.
"I think people are going to fall away as the system gets more complicated," Seckel told the Courier-Journal. "It's an experiment and there's some peril in it."
"We're all very, very concerned," said associate professor of public health Muriel Harris at the University of Louisville. "Those who have made the decisions are not considering the population we serve. It's just undermining any gains we have made in the past."