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Michael A. Cohen

Kentucky’s crusade to strip health coverage from its most vulnerable citizens

Governor Matt Bevin of Kentucky.AP Photo/John Minchillo

Supreme Court Justice Louis Brandeis once said that state governments are the laboratories of democracy.

These days in Kentucky, it looks more like a torture chamber. The state’s Republican governor, Matt Bevin, is seemingly on a political crusade to take health care coverage away from hundreds of thousands of his state’s most vulnerable citizens.

Earlier this year, Kentucky became the first state in the country to receive approval from the Trump administration to impose work requirements on its citizens who receive Medicaid benefits.

Kentucky is one of four states to get such approval from the Department of Health and Human Services, and several more such applications are in the pipeline.


The idea of forcing poor people to work for health care coverage — and deal with onerous reporting requirements — is unbearably cruel, even for an administration defined by its extreme heartlessness. But it’s also one that hurts state governments and does little to save money, which is often how such initiatives are justified.

For Kentucky, the decision is particularly hard to figure out, because the state has benefited immeasurably from expanding Medicaid coverage, which was a key aspect of Obamacare.

From 2013 to 2016, the uninsured rate in the state fell from 14.9 percent to 5.5 percent. Expanded access to care pumped billions of dollars into Kentucky’s economy and created thousands of new jobs. Much of that improvement was the result of the Medicaid expansion, as more than 650,000 Kentuckians are enrolled in the health care program.

But Bevin had run on a platform of repealing evil Obamacare, and as we’ve learned over the years, Republican views on Obamacare are not affected by facts or lives helped. For the GOP, Obamacare is terrible and always will be.


The demand for work requirements would have meant that close to 100,000 residents would lose coverage, which is why last month a US District Court judge blocked imposition of the new rules. According to the court, the Trump administration failed to take into account the fact that so many people would lose coverage, which is inconsistent with the program’s goal of increasing health care access.

So what did Bevin do after being shot down by the court? Days later — and with no warning to the public — Bevin unilaterally took away dental and vision coverage for 460,000 state residents.

The decision wreaked immediate and predictable chaos. Thousands of patients, some with ongoing dental emergencies and many unaware that they had lost coverage, were turned away from dentists’ offices across the state.

Kentucky is already the fourth poorest state in the country. Its residents also have some of the nation’s worst oral health. It’s hard to view Bevin’s decision as anything other than a mean-spirited and callous response to a federal court ruling . . . that judged his initial effort to impose work requirements on Medicaid recipients as mean-spirited and callous. When people talk rhetorically about the GOP’s war on poor Americans, Bevin’s unceasing efforts to take health care coverage from hundreds of thousands of his state’s residents is Exhibit A.

Thankfully, it took only three weeks of outcry for Kentucky to reverse course and restore the cut dental and vision coverage.

But what is perhaps the most enraging element of these anti-Medicaid efforts is that they are based, almost exclusively, on a lie.


When Bevin announced his decision to slash dental and vision benefits, he called it an “unfortunate consequence” of the district court’s ruling and said the rollbacks were needed to save the state money.

According to his administration, the initial work requirement plan would have saved the state $300 million to $400 million over five years. The problem with that argument is that the cuts in Medicaid spending by the state would end up costing Kentucky $2 billion in federal money for the Medicaid program. Then, of course, there are the higher costs that come from so many Kentuckians losing coverage; the lost productivity from workers too sick to do their job; and the diminished revenues for hospitals, clinics, and doctors.

But perhaps most enraging of all is a recent report from the credit agency, Fitch Ratings, which found that Kentucky’s Medicaid administration costs have jumped more than 40 percent (or $35 million). Those added costs are a result of the burden placed on state officials in implementing Medicaid work requirements.

That’s right; in order to reduce enrollment in a government program (a longstanding conservative aspiration), Kentucky has dramatically increased the state’s bureaucracy (the opposite of longstanding conservative aspirations).

It’s almost as if the stated goal of reducing the size of government isn’t really the objective — and undermining a public program with Barack Obama’s name on it is, even at a cost to hundreds of thousands of state residents. For Kentucky, state government isn’t a laboratory for what Brandeis called “novel social and economic experiments.” It’s a place to subject the nation’s poorest citizens to even greater hardship.


Michael A. Cohen’s column appears regularly in the Globe. Follow him on Twitter @speechboy71.