In 2014, the Affordable Care Act (ACA) allowed for the expansion of Medicaid in Kentucky, providing healthcare for over 440,000 residents of low income households statewide. USA Today’s The Gleaner tells one story of how a 56-year-old woman named Freida Lockaby received her first health insurance in over a decade due to that expansion. She called it a “godsend.” Another resident Ramiro Salazar, who survives on $733 a month with his wife and two children, obtained through Medicaid, coverage to include his medications and transportation costs to doctor’s visits.
Now, Kentucky and other states are finding it difficult to maintain Medicaid affordability despite staggering drops in uninsured rates. See Kentucky’s major dip in uninsured from 20% in 2013 to 7.5% in 2015. In the coming year, though, budgetary concerns loom overhead. Kentucky governor Matt Bevin does not see the ACA as being the “godsend” that its low income residents feel it is. In the coming year, Bevin projects $1.2 billion in Medicaid expenses through 2021.
His solution? Have residents pay premiums ranging from $1 to $37.50 and barter community service in exchange for free vision and dental care. This rule would not apply to the disabled, but to those capable of working in exchange for coverage of certain aspects of their healthcare. Bevin has cautiously warned that Medicaid expansion within Kentucky may be dialed back should something not give with regard to the ACA. He’s not alone in his concerns, as 31 states and Washington D.C.—all places that have participated in Medicaid expansion—will experience similar increases in expenses.
But what will this mean for those living in poverty and finally receiving healthcare? Should President-Elect Donald Trump repeal the Affordable Care Act in ostensible exchange for health pools and HSAs, will residents of impoverished communities receive adequate healthcare as they do now? Will Medicaid expansion be halted indefinitely, and ACA marketplace exchanges with low competition amongst providers be privatized? The concerns run amok for those who previously couldn’t afford healthcare but can for now. We’ll have to wait and see.