Will Medicaid changes ‘heal or hurt?' Kentuckians disagree in Louisville debate
LOUISVILLE — As Republicans in Washington advanced a proposed Medicaid work requirement Wednesday, two Kentucky advocates speaking in Louisville disagreed on the wisdom of the policy.
A House committee chaired by U.S. Rep. Brett Guthrie, R-Bowling Green, approved a plan for trimming $625 billion in federal Medicaid spending over the next decade that includes new copays and work and reporting requirements. The vote is an early step in moving the changes, part of a massive tax and spending bill, through both chambers of Congress. The federal Medicaid work requirement would not take effect until 2029, under the bill approved by Guthrie's House Energy and Commerce Committee during a marathon session that lasted 25 hours.
U.S. House panel passes GOP plan that cuts Medicaid by $625B, adds work requirement
The federal-state Medicaid program pays for almost 1 in 3 Kentuckians' health care.
The Louisville Forum already was planning to host a debate around the question: Will changes to Medicaid 'heal or hurt?' after Medicaid also took center stage in Kentucky's 2025 legislative session.
Deborah Yetter, a Kentucky Hall of Fame journalist who writes for the Lantern, moderated the Wednesday panel between Jim Waters, president of the Bluegrass Institute for Public Policy Solutions, and Emily Beauregard, executive director of Kentucky Voices for Health.
Waters and Beauregard spent a large chunk of the debate discussing the ins and outs of Medicaid work requirements.
During the legislative session Kentucky lawmakers added a mandated work requirement for Kentuckians between the ages of 18 and 60 who don't have dependents and are both 'physically and mentally able to work.'
Waters said that 'there's going to be some hurt whenever you try to rein in a program that's really exploded in cost' and said Medicaid 'was intended to be for the truly disabled, indigent.'
District of Columbia 38%
Alaska 36%
New Mexico 36%
California 35%
New York 34%
Louisiana 34%
Kentucky 31%
Oregon 31%
Hawaii 29%
West Virginia 29%
50 states and D.C. 24%
Source: Center for Budget and Policy Priorities
'It was not meant to be a destination,' he said. 'It was meant to help along the way.'
'Contrary to maybe what some people think, there is not an automated taxpayer machine there in Frankfort,' he said. 'I mean, taxpayers are not an endless source of resources, so resources are limited, and they need to be spent in a way that actually helps people.'
Beauregard said 'we don't need work requirements for Medicaid' and said reporting requirements often lead to administrative hurdles that keep people from being able to prove their employment, such as hard-to-prove seasonal work or literacy issues.
Beauregard said work requirements are 'short sighted' because 'it is a prerequisite to work that you are healthy.'
'While we do spend a decent amount of money on Medicaid, the cost of being uninsured is much greater — and it's not only greater to the individual, it's greater to our entire economy and to our health care system,' she said.
For Waters, Medicaid is 'unsustainable' as it is.
'Don't we want fewer people on Medicaid? I think that should be the goal,' Waters said. 'Fewer people on Medicaid means when people are in the private workforce getting coverage from employers, are independent, are experiencing the dignity of work and effort,' he said. 'If everybody, pretty much, is working …. that's receiving Medicaid benefits now, like I've heard, and then it's a very small percentage that aren't, what's the problem with implementing a program that gets the rest of those folks onto an employer's payroll and off of the taxpayers' benefit plan.'
Lawmakers have cited fraud prevention as a motivator to more thoroughly oversee and rein in Medicaid.
Beauregard said 'there's very little fraud for individuals' and that fraud is 'mostly in the provider arena, and it's not widespread.'
'Individuals aren't able to take advantage of their Medicaid coverage for nonmedical purposes,' she said. 'You can't take your Medicaid card and use it to purchase groceries or go on a vacation. Very few people are getting a root canal for the fun of it.'
Waters believes 'there's more fraud that we even know right now' and called on the newly established Medicaid Oversight and Advisory Board to 'be aggressive in looking at what fraud is happening and the extent of it.'
'Taxpayers deserve to know what that is, and to have somebody looking at that,' he said.
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Lindsey Graham, a Republican from South Carolina, has also drawn a GOP challenger in his 2026 bid for reelection. Paul Dans, the original author of Project 2025, a sweeping conservative agenda to overhaul the federal government, announced his entrance into the race at an event in Charleston July 30. More: Lindsey Graham gets Republican challenger: Project 2025 author to announce Senate bid The primary contest will likely pit MAGA voters in the Palmetto State against one another. Though Graham has previously been a regular target of criticism from Trump − displeased by the lawmaker at times breaking from the GOP leader − he is currently an ally to the president and has already received Trump's 'complete and total endorsement.' Dans' primary challenge will be an uphill battle. Should Graham come out on top, he is heavily favored to win a fifth term representing the Palmetto State. 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With the state's blue tilt, Smith's seat has a good chance of staying in Democrats' hands. More: 'Entirely personal': Democrat Tina Smith to not seek reelection in 2026 Minnesota Lt. Gov. Peggy Flanagan and Rep. Annie Craig are among the frontrunners for their party's nomination. Minnesota Gov. Tim Walz, 2024 Democratic presidential nominee Kamala Harris' running mate, opted back in February not to run for Senate. On the Republican side, former NBA player Royce White is running again, after losing his bid against Sen. Amy Klobuchar in 2024. Former Navy SEAL Adam Schwarze has also announced his campaign for the GOP nomination. The Minnesota primaries will be held Aug. 11. 8. Ohio The Buckeye State represents one of Democrats' few pick up opportunities, and even then it will not be an easy flip. Republican Sen. Jon Husted was picked by Ohio's governor to fill the seat vacated by Vice President JD Vance at the start of the year, and Husted will be on the ballot next November to keep his spot. Ohio has become reliably red in recent years, making the fight to flip it tough for Democrats. Their best shot likely is former Democratic Sen. Sherrod Brown, who lost his bid for reelection last year to Sen. Bernie Moreno. Axios reported that Brown met with Majority Leader Chuck Schumer in late July, as part of the top Senate Democrat's efforts to lobby Brown to run again. 9. New Hampshire Democratic Sen. Jeanne Shaheen of New Hampshire announced she would not be seeking another term in 2026 either. Democratic Rep. Chris Pappas, who launched his campaign in April, is widely seen as a strong contender to succeed Shaheen. More: Former GOP Massachusetts Senator Scott Brown running for Senate in New Hampshire Republican Scott Brown, a former Massachusetts senator and ex-ambassador to New Zealand and Samoa under Trump's first term, is among a handful of candidates competing on the GOP side. Like Minnesota, Cook Political Report has rated New Hampshire's race leaning Democrat. 10. Iowa In Iowa, Sen. Joni Ernst, a Republican, has the advantage, with Cook Political Report rating her race likely Republican. Three Democrats so far have launched bids in hopes of beating those odds: Nathan Sage, the former chamber of commerce director from Knoxville; state Rep. J.D. Scholten; and state Sen. Zach Wahls. More: Iowa Democratic Rep. and minor league pitcher J.D. Scholten to run against Sen. Joni Ernst Trump's sweeping tax, spending and policy bill, passed into law earlier this summer, is expected to be a defining issue in Iowa's race. Ernst was one of 50 Senate Republicans who voted in favor of the legislation, which her Democratic opponents decried as a move "to gut Medicaid for hundreds of thousands of Iowa children and families." The primary in Iowa is scheduled for June 2. 11. Nebraska Nebraska is widely seen as a Republican stronghold with incumbent GOP Sen. Pete Ricketts, though there could be a surprisingly competitive race in 2026 with Independent candidate Dan Osborn jumping back into a statewide election. More: Nebraska independent Dan Osborn could be poised to shake up U.S. Senate Osborn came within seven percentage points of beating Sen. Deb Fischer in 2024, a closer-than-expected margin in the GOP-dominated state. Osborn, a former labor leader, is a registered Independent but received campaign contributions from Democrats in his last campaign (money he told NBC he did not ask for). Ricketts, a former Nebraska governor and part owner with his family of the Chicago Cubs, is running for a full term after being appointed to the job in January of 2023 upon the resignation of Republican Sen. Ben Sasse.
