Whether or not you’ve ever needed it, Medicaid forms the bedrock of Kentucky’s entire healthcare system, making coverage more affordable and accessible for all of us. As our single largest source of federal funding, it also sustains thousands of jobs, keeps rural hospitals and clinics open, and injects billions into our local economies each year. Almost 1.5 million Kentuckians count on this coverage, from our youngest, to our oldest, and everyone in between, including working families, people with disabilities, and anyone who finds themselves in need of costly or long-term care they couldn’t otherwise afford.
Kentucky’s population is rapidly aging, which means more of us are discovering that it’s often Medicaid (not Medicare) that’s there when we need help with nursing care, home health, or assisted living. As we weather the aging boom, Medicaid’s critical significance in our lives will only grow.
Claiming to safeguard the future of the program, Congress has pushed through the largest cuts in Medicaid’s history. These “big, beautiful” cuts, rushed in over a few short weeks this summer, exceed the scale of all previous reductions combined. It has left many wondering how exactly the program is being protected.
The largest cuts from the One Big Beautiful Bill Act (OBBBA) come from terminating coverage for people who can’t meet new work reporting requirements. Supporters of the change have worked hard to sell a particular stereotype, painting pictures of young men somehow living high off their health insurance. But that certainly isn’t the case in Kentucky. In reality, the “able-bodied adults without dependents” these requirements target are most likely to be middle-aged women with a high school degree or less, who have caregiving responsibilities at home. Many are caring for a parent, sibling, or spouse who may not legally count as a dependent, but whose needs keep them from fully participating in the workforce. In Kentucky, nearly one in five Medicaid enrollees who aren’t working full-time are doing exactly that: providing essential care to their loved ones.
The image of a young man sitting in a basement playing video games distracts us from the reality of a single mom juggling elder care with whatever odd jobs she can squeeze in. These women aren’t gaming the system, they’re sustaining it. It is their often unrecognized and unpaid labor that saves millions in long-term care costs, yet the Big Beautiful Bill threatens to punish them for not fitting narrow reporting requirements.
But the new hurdles won’t stop there. They pile on paperwork, reporting deadlines, and exemption applications that overwhelm the very people Medicaid is meant to help. Working parents, gig workers, farmers, and Kentuckians facing barriers like unreliable transportation, fluctuating hours, or limited internet access will struggle to keep up. The result? Coverage losses. These new requirements won’t boost employment, but they will double our rate of uninsured, strain our hospitals with uncompensated care, and push more families into medical debt.
If lawmakers truly wanted to “save” Medicaid, they have options. Too many Kentuckians face a benefit cliff when increased earnings put them over the eligibility limit for Medicaid but aren’t enough to cover the cost of commercial insurance. Providers like dentists are woefully underpaid through base reimbursements. Life-changing medications are currently excluded from coverage. And quality care isn’t incentivized the way it should be.
Congress could have tackled any of these issues. Instead, the Big Beautiful Bill weakens Medicaid across the board, straining our entire healthcare infrastructure, reducing access, and driving up costs for everyone. The truth is, Medicaid didn’t need saving. But it does now.
This column ran in the Lexington Herald-Leader and Kentucky Lantern on Sept. 3 and the State Journal on Sept. 11.
