visit PBS.org slash NewsHour. Canada Donald Trump promised to repeal President Obama's Affordable Care Act, also known as Obamacare, and the new Republican Majorities in Congress, share that agenda, though they have not proposed a specific program to replace it. However, this process is already underway in Kentucky, the home state of Senate Majority Leader Mitch McConnell. The state has had one of the highest rates of Obamacare enrollment, mainly due to its Medicaid expansion. In fact, two-thirds of Americans who've obtained health insurance under Obamacare were poor enough to qualify through Medicaid. But two years ago, Kentucky elected a Republican governor who promised to roll it back. In tonight's signature segment, NewsHour Weekend Special Correspondent Chris Bury reports how that's playing out. This report is part of the NewsHour's ongoing look at the 44th President's legacy, the Obama years. We're used to it now. For Steve and Melanie Uxner, the Affordable Care Act has meant life-saving health care without going broke.
Steve, who is 60, has throat cancer. Every day we look like we seem to be getting a little bit better. His treatments, including chemotherapy and radiation, are covered by Medicaid, the federal government health program, for low-income and disabled Americans. The Uxner's qualified after the act known as Obamacare took effect, but the cancer, chemo and radiation have taken their toll, leaving burns on Steve's neck and costing him his voice. Are they giving you like a topical steroid for that? No, I've been using cocoa bars. Melanie speaks for both of them. What is having this insurance meant for Steve's health? With the Medicaid, we've paid nothing. I mean, it has covered, every ounce of it. So, I mean, peace of mind has just been just absolutely tremendous. The Uxner's, who take care of their three-year-old granddaughter, now get health insurance because Kentucky, like 31 other states, agreed to expand Medicaid under Obamacare.
Before qualifying for Medicaid, Steve relied on private insurance from the company that owned the gas station where he worked, which Melanie says, paid a maximum of only $2,000 a year in benefits. I'm going to put a note in with the billing department. After Steve was diagnosed with cancer in 2009, his treatments ran up bills of more than $100,000 before the couple qualified for Medicaid in 2014. Would you be deeply in debt if you didn't have this insurance? We are deeply in debt from not having it before, yeah. And we would be even more deeply in debt, yeah, selling this house wouldn't get us out from it. Under the Affordable Care Act, Kentucky, like 17 other states and Washington, DC, set up its own health insurance exchange. Kentucky called theirs Connect. Residents could sign up for private insurance often with government subsidies. Yet for every Kentucky resident who obtained private insurance this way, another four residents got coverage through Medicaid expansion.
The expansion raised the income eligibility to 138% of the federal poverty line. That's about $16,000 a year for an individual and $33,000 for a family of four. Here in Kentucky, the rollout of the Affordable Care Act in 2013 was considered such a success. It became a model for other states. In the first few months, more than 300,000 people qualified for Medicaid coverage under the new law. And Kentucky saw a dramatic decrease in the percentage of uninsured residents, one of the biggest drops of its kind in the country. In 2013, nearly 19% of Kentucky's non-elderly population had no health insurance. By 2015, the uninsured rate had fallen to less than 7%. That's better than the national rate of the uninsured, which has dropped to 10.5%. Former Kentucky governor Steve Beshear, a Democrat pushed for both a state exchange
and Medicaid expansion under the Affordable Care Act. I didn't care who passed it. I didn't care whether it was Democrat or Republican in terms of politics. I mean, it was the one opportunity that I felt like we had to make a big difference in Kentucky in the next generation or so in our health. That difference is seen in a study published by the Journal of the American Medical Association last October. It found Kentucky's newly insured in the first two years of Medicaid expansion received more primary and preventive care, made fewer emergency room visits, and reported better health. But in Kentucky, like many states that usually vote Republican for president, Obamacare became a political punching bag. And in 2015, Republican Matt Bevin successfully ran for governor, promising to roll back parts of the law if elected. Last year, Kentucky eliminated its state exchange, saying it was redundant given the federal exchange
to help control costs. Governor Bevin also asked the federal government for permission, known as a waiver, to overhaul the state's Medicaid program, which now covers 1.3 million people, almost one in three residents. I want to see us become a healthier state. I don't want us simply to provide people with a Medicaid card and feel like we've done our part. We owe people better than that. The governor declined our interview request, but Republican state representative, Addia Wuchner, who chairs the state committee on health and family services, supports his plan. The goal is to help every individual that is being served by traditional Medicaid or expanded Medicaid or moving into the exchange to learn to utilize the tools of having insurance and coverage. Are you saying it provides an incentive? So it allows them to have that skin of the game, to be consumers, but also taking that responsibility. Under Bevin's plan, Medicaid would no longer be free.
Recipients would be charged monthly premiums up to $15 a month or $180 a year. Able-bodied recipients without dependence would be required to work or volunteer up to 20 hours a week or to be enrolled in school. Those eligible for expanded Medicaid who miss a single premium payment could lose coverage for at least six months. $180 a year to have this almost the same coverage that you and I would have. That's a pretty good deal. So the governor's not asking, nor are we
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