One can say this about the hoops Kentucky will require low-income residents to jump through to become eligible for Medicaid: If you were deliberately trying to come up with ways to throw people off the program, you couldn’t do better.

It’s been widely reported that the “waiver” of Medicaid rules approved for the state by federal officials last week includes a first-in-the-nation work requirement. (Our initial take on the waiver can be found here.) But there’s much more to it, none of it good if you are a Medicaid enrollee or someone who believes that the purpose of government healthcare programs is to provide people with healthcare.

“Coverage is at risk for large numbers of low-income adults and families,” says Judith Solomon, a health policy expert at the Center on Budget and Policy Priorities. Kentucky’s own figures show that as many as 100,000 people could lose their coverage within five years — that’s about 15% of the state’s Medicaid population. “Many of those affected are likely to be older, and many will be people who suffer from mental illness, substance use disorders, and chronic health problems,” Solomon says.

What’s more disturbing is that Kentucky’s changes, if they can pass legal muster, could be the precursor of similar approaches in states such as Arizona, Arkansas, Indiana, Kansas, Maine, Wisconsin and Utah, where Republican leaders have filed applications resembling Kentucky’s.

What’s bizarre to the point of insanity about these changes in Kentucky’s healthcare policies is that few states need the government’s help in making its residents healthier than this one. According to the state’s own figures — mustered, oddly, to justify cutting back on Medicaid — it’s one of the unhealthiest states in the union. It ranks worst in the nation in cancer death rates, has the second-highest smoking rate and seventh highest obesity rate. Eight of the 13 counties in the U.S. with the largest declines in life expectancy are in Kentucky.

In the face of this grim profile, Gov. Matt Bevin thinks too many Kentuckians get too much healthcare. We’d ask what he’s thinking, but plainly he isn’t thinking at all.

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Kentucky’s new obstacles to Medicaid coverage are crueler than you could imagine