Kentucky is in the national spotlight but, once again, for an accolade we would rather not claim.
Gov. Matt Bevin’s waiver made Kentucky the first state to require residents to prove they are working in order to receive health insurance through Medicaid.
Fearing legal challenges, Bevin then issued an executive order threatening to revoke Medicaid expansion altogether if his new work mandate is challenged.
As medical students who call Kentucky home, this news comes as bitter disappointment as we think of the nearly half-million people at risk of losing lifesaving care.
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At its core, Bevin’s plan rests on the false notion that people must have a job to prove themselves worthy of health care. He views Kentuckians in need as budgetary burdens to be fixed instead of individuals facing difficult situations in need of support and compassion.
It follows from the same faulty reasoning that says Kentuckians without a job simply don’t want to be employed, that if we punish them, they will rise to the occasion.
In Bevin’s words, he wants them “to have some skin in the game.”
But in places like Magoffin County where the unemployment rate is 12.7 percent and climbing, further penalizing residents by taking away health care is a solution lacking in compassion and vision.
The stories we know — of eviction, poverty, addiction, family upheaval, and debilitating illness — demand we acknowledge joblessness in Kentucky as rooted not in choice, but circumstance.
Medicaid was never intended to wage threats or impose conditions on the poor and vulnerable. It was built into the fabric of this country on the principle that everyone, regardless of income, deserves access to the fundamental human right of health care. Linking eligibility to employment is at odds with this core tenet.
Kentucky, in particular, has benefited uniquely from this program. Since 2013, Kentucky’s Medicaid enrollment has increased by 105 percent, making it the most successful state in the nation at reducing its rate of uninsured residents.
Despite our unparalleled success with Medicaid, Bevin seems to remain intent to dismantle it. By stripping insurance from thousands of newly insured Kentuckians, his work requirement will undermine the progress so tenuously made in recent years.
Moreover, studies have already shown that work requirements often fail to reduce unemployment, and often leave low-income communities even poorer by dissolving access to vital resources.
Another glaring oversight is the potential to exacerbate the opioid epidemic. As Medicaid expansion required coverage for addiction treatment, access to several treatment services in Kentucky improved by as much as 75 percent.
Bevin’s policy will withdraw care from many Kentuckians struggling with addiction, preventing them from accessing the help they need to overcome this all-consuming disease.
Other punitive measures include a rule that failure to report fluctuations in income within 10 days will result in revoking of Medicaid eligibility. This greatly disadvantages low-paid workers with seasonal variability or wage earners relying on tips and commission, who will be at constant risk of losing coverage.
Bevin’s myopic view of social stagnation in Kentucky reveals a laziness in his own policy: his eagerness to conflate solutions to two problems that require individual attention.
While we agree having a steady income is intrinsic to holistic health, we know the reverse also holds true: Patients must be healthy in order to find and keep a steady job.
Those jobs must also be available and accessible in the first place, and the state must invest in creating them where they don’t exist rather than assuming they are there for the taking.
In the meantime, our patients deserve health care in their own right — and by making our state a healthier one where people are insured and able to work, we make strides towards economic progress.
That Bevin cannot grasp these basic realities reveals a governor out of touch with the people who elected him into office.
Darshali Vyas of Lexington is a medical student at Harvard Medical School. Brandi Jones, of Louisville, is a medical student at University of Louisville.