Kentucky is Ground Zero for the ongoing partisan fight over the Affordable Care Act.

When the ACA was first implemented in 2014, Kentucky, led by Democratic Gov. Steve Beshear, enthusiastically set up its own insurance marketplace and embraced the (nearly entirely) federally funded Medicaid expansion.

However, power switched hands at the beginning of 2015, with Republican Gov. Matt Bevin taking office after a campaign in which he railed against the ACA. His administration is currently in the process of closing the state-run exchange, KyConnect, and it is embroiled in a fierce battle with Democrats over what to do about the state’s Medicaid expansion.

Although Bevin has backed off his initial promise to undo the Medicaid expansion, he is now pushing to impose a number of requirements on the new beneficiaries. In addition to certain work requirements, he wants beneficiaries to pay premiums, ranging from $1 to $15 a month, for their coverage.

While the federal government will continue to pay 90 percent of the cost of the Medicaid expansion, Bevin has contended that the small portion of the tab that his state must pick up is too expensive.

The Obama administration currently does not allow work requirements to be tied to the expansion. Bevin is applying for a waiver, and has said he will eliminate the Medicaid expansion entirely if the feds don’t help him out.

“The commonwealth’s expansion of Medicaid will now lie in the hands of" the Obama administration, he said last month.

Kentucky already has stricter rules for its ACA plans than some other states. The state allows insurers, for instance, to charge smokers up to 40 percent more for health plans. That move, some experts say, has unfortunately deterred many smokers of modest means from buying insurance altogether.

The Blue Grass State experienced one of the greatest increases in health care coverage as a result. According to a Gallup poll, its uninsured rate dropped from 20.4 percent in 2013 to 7.5 percent at the end of 2015. Only Arkansas, a state with an even higher rate of poverty, saw a greater change.

Similar to Kentucky, Arkansas elected a Republican governor in 2014, Asa Hutchinson, who has also sought to make changes to the Medicaid expansion that his Democratic predecessor, Mike Beebe, embraced.

Instant Insights /

Kentucky confronting Obama administration over ACA waiver

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