Last Call For Dispatches From Bevinstan, Con't.

The people of Kentucky voted for Matt Bevin by a considerable margin last year, a man who promised to end Medicaid for 450,000 Kentuckians.  The only thing standing in his way was the Obama administration's Health and Human Services department, and Democrats in the Kentucky House.  Last week many of these same Kentuckians voted for, by an even larger margin, to get rid of both of those checks.

Now, some of them are worried they might lose their Medicaid.  They should be terrified.

For Freida Lockaby, an unemployed 56-year-old woman who lives with her dog in an aging mobile home in Manchester, Ky., one of America's poorest places, the Affordable Care Act was life altering.

The law allowed Kentucky to expand Medicaid in 2014 and made Lockaby – along with 440,000 other low-income state residents – newly eligible for free health care under the state-federal insurance program. Enrollment gave Lockaby her first insurance in 11 years.

"It's been a godsend to me," said the former Ohio school custodian who moved to Kentucky a decade ago.

Lockaby finally got treated for a thyroid disorder that had left her so exhausted she'd almost taken root in her living room chair. Cataract surgery let her see clearly again. A carpal tunnel operation on her left hand eased her pain and helped her sleep better. Daily medications brought her high blood pressure and elevated cholesterol level under control.

But Lockaby is worried her good fortune could soon end. Her future access to health care now hinges on a controversial proposal to revamp the program that her state's Republican governor has submitted to the Obama administration.

I guarantee you Lockaby and her neighbors voted for Bevin last year and Trump this year.  And I bet that even if Lockaby herself did find it in her heart to vote for Jack Conway or Hillary Clinton, her neighbors saw the health care she was getting and figured she was one of those people who needed to be out there working like they are. They definitely voted for Bevin and Trump to take health care away from her. I'm willing to put actual money on the table that at least one of Frieda Lockaby's neighbors said "I know she's healthy enough to find a job, she's living off the government, and that's not fair.  That's why I voted for Trump."

Bevin has threatened to roll back the expansion if the Obama administration doesn't allow him to make major changes, such as requiring Kentucky's beneficiaries to pay monthly premiums of $1 to $37.50 and require nondisabled recipients to work or do community service for free dental and vision care.

Budget pressures are set to rise next year in the 31 states and the District of Columbia where Medicaid was expanded as the federal government reduces its share of those costs. States will pick up 5 percent next year and that will rise gradually to 10 percent by 2020. Under the health law, the federal government paid the full cost of the Medicaid expansion population for 2014-2016.

In a state as cash-strapped as Kentucky, the increased expenses ahead for Medicaid will be significant in Bevin's view — $1.2 billion from 2017 to 2021, according to the waiver request he's made to the Obama administration to change how Medicaid works in his state.

Trump's unexpected victory may help Bevin's chances of winning approval. Before the election, many analysts expected federal officials to reject the governor's plan by the end of the year on the grounds that it would roll back gains in expected coverage.

A Trump administration could decide the matter differently, said Emily Beauregard, executive director of Kentucky Voice for Health, an advocacy group that opposes most waiver changes because they could reduce access to care.

"I think it's much more likely that a waiver could be approved under the Trump administration," she said. "On the other hand, I wonder if the waiver will be a moot point under a Trump administration, assuming that major pieces of the [Affordable Care Act] are repealed."

Lockaby is watching with alarm: "I am worried to death about it."

You should be. Donald Trump won every single county in Kentucky except for Fayette and Jefferson, where Lexington and Louisville are, respectively.  Trump won Clay County 87%-11%. They voted overwhelmingly to take everything away from those people.

It turns out "those people" are Frieda Lockaby herself.