The New York Times has a good piece on Bevin's threats:
Apparently the plan to Make America Great Again will let some Americans die.
Kentucky rushed last week to become the first of the nation’s 50 states to impose a work requirement on recipients of Medicaid. Under the state’s HEALTH plan, most able-bodied 19-to-64-year-olds — excluding the pregnant, the medically frail and some others — will have to work, get job training or perform community service for at least 20 hours a week to qualify for coverage, starting in July.
They will have to pay for it, too — a premium starting at $1 per month for families living on up to one-quarter of the federal poverty line, or about $400 a month for a family of three (such families exist, apparently) and rising to $15 for those who manage to stay above the poverty threshold.
The initiative is, of course, not about saving the state money by pushing poor people off the insurance rolls. It is providing moral education. In the words of Gov. Matt Bevin, the HEALTH plan will free Kentuckians from the “dead-end entitlement trap” and give them “a path forward and upward” so they can fend for themselves.
But the fact remains that the plan is expected to reduce Medicaid spending by $2.4 billion over five years. Roughly half of the 350,000 able-bodied Medicaid beneficiaries in Kentucky currently do not meet the work requirements, by the government’s estimates, and could lose their benefits. Five years from now, the Bevin administration calculates, the change will have culled some 100,000 people from the rolls.
Kentucky won’t be the last. Arizona, Arkansas, Indiana, Kansas, Maine, New Hampshire, North Carolina, Utah and Wisconsin have already submitted their own similar proposals. Barring legal challenges, the Trump administration is eager to let them do it. Millions of Americans stand at risk of losing their health care. Many — the most fragile, the least great — could die as a result.
Mr. Bevin might care to glance south over the border. In 2005, Tennessee removed 170,000 people — almost one in 10 Medicaid beneficiaries in the state, mainly working-age adults without children — from its Medicaid program to save money. They didn’t do well.
The cuts didn’t just eat into poor Tennesseans’ finances. One study found that childless adults in Tennessee — especially the least educated — started delaying or forgoing visits to the doctor. They reported suffering more days in bad health and incapacitated. And they recorded more visits to hospital emergency rooms, which are required by law to care for all comers, regardless of their ability to pay.
Another study from Tennessee found that losing access to Medicaid led to delays in diagnosis, so more breast cancers were caught at a later stage. Women who lived in low-income ZIP codes were 3.3 percentage points more likely to receive a diagnosis of late-stage cancer than women living in high-income ZIP codes.
Kentucky was an eager participant in the last big so-called entitlement reform, visited upon the nation’s poor just over two decades ago. Under that 1996 program directed at welfare benefits, the entitlement to federal assistance was replaced by a hodgepodge of programs managed by the states and financed by a fixed dollop of federal cash. Work requirements became the norm. And people got less help.
The number of families in poverty in Kentucky has budged little since then, declining to 116,000 from 132,000. But the number of families getting cash assistance has fallen by two-thirds. Today, the Temporary Assistance for Needy Families program covers only one of five poor families in the state. For a single mother with two children, it provides $262 a month — a third less than it did two decades ago, adjusted for inflation.