Kentucky broke with Tennessee and most other Southern states when it embraced the ACA and expanded Medicaid. In May 2013, then governor Steve Beshear, a Democrat, announced to much fanfare and predictable resistance that the state would expand Medicaid to cover most adults with incomes under 138 percent of the federal poverty level and support insurance marketplaces as well. Beshear called the expansion “the single most important decision in our lifetime” for improving the health of Kentuckians—who traditionally ranked near the bottom of the US population in nearly every health indicator.
