Medicaid overhaul faces tough test in Trump country

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Kentucky Gov. Matt Bevin’s planned overhaul of Medicaid is running into the unforgiving reality of impoverished small towns like this one, which voted overwhelmingly for President Donald Trump.

Making adults work as a condition for getting health benefits is popular with the conservatives running many state capitals and Washington, D.C. But here in Magoffin County, where one of the last coal mines shuttered two years ago, there is little work to be had.

Trump’s Health and Human Services Department is expected to bless Bevin’s plan requiring poor adults to work to enroll in Medicaid in a first test of the GOP idea nationwide. Arizona, Arkansas, Indiana, Maine and Wisconsin have already asked the federal government for similar permissions, or will do so soon.

Trump’s top health officials, along with many Blue Grass Republicans, argue the work and other new requirements would bring much-needed discipline to a program that’s grown by more than 11 million people nationally under Obamacare’s coverage expansion.

“If I had my way, everybody who is able to work would be required to work for any program there is,” said Sen. Rand Paul (R-Ky.). “I think work is a good thing, not a bad thing. I don’t think work is punishment.”

“I think it incentivizes people to get out there,” agreed Kentucky state Sen. Ralph Alvarado, a physician, who said that able-bodied individuals relying on public assistance should find ways to give back to their communities.

Medicaid was never meant for “able-bodied” adults who obtained coverage under Obamacare and the program must be protected for more vulnerable populations, Alvarado said.

Under Kentucky’s proposal, able-bodied, low-income adults would be required to work up to 20 hours per week, or pursue activities such as job training or volunteer work to be eligible for Medicaid coverage. The state is also seeking federal approval for other conservative policies, including instituting monthly premiums ranging from $1 to $15 for certain low-income adults and parents, and co-pays if individuals miss premium payments.

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