KENTUCKY, a poor, rural state nostalgic for coal, has never been quite sure of its politics. For three years it was the darling of Obamacare. Governor Steve Beshear, a rare Appalachian Democrat, complied with the reform by creating a statewide health-insurance exchange and expanding Medicaid (government-subsidised coverage for the poor and disabled). Between 2013 and 2015, uninsured rates for poor adults fell from 40% to 9%—the biggest improvement in the country. But now that the state is under new management—the Republican governor, Matt Bevin (pictured above), is a Tea Party favourite—Kentucky may soon be notable in health-policy circles for a new reason: it wants to become the first state in history to require some Medicaid recipients to work.
Other states with Republican governors, including Indiana and Arkansas, hope to follow. Before long, the health-care safety nets in these states may look very different from those in Democratic ones—and indeed from those in other rich countries,...Continue reading
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