Dying of Whiteness: How the Politics of Racial Resentment Is Killing America's Heartland

by Jonathan M. Metzl

Only three years after that announcement, Kentucky voters elected a new Republican governor, Matt Bevin, who ran on a promise to dismantle the ACA and Medicaid expansion. In June 2016, Bevin laid out plans to close the state-run Obamacare insurance marketplace and roll back Medicaid. Yet even in the data from late 2013 to early 2016, the effects of expansion in Kentucky posed a stark contrast to trends seen in Tennessee: 425,000 Kentuckians, representing fully 10 percent of the population, gained coverage in the first year alone—even though the Medicaid expansion did not go into effect until a year later. According to an in-depth study published in Health Affairs, the percentages of the state’s low-income adults without insurance dropped from 40.2 percent to 12.4 percent as a result of expansion—one of the largest reductions in the country. Increasing numbers of Kentuckians visited doctors. The state also saw reductions in the numbers of people who skipped taking their medications because of cost or claimed to have difficulties paying their medical bills.10