FRANKFORT, Ky. - Medicaid turns 50 Thursday, and in Kentucky, with expansion under the Affordable Care Act, enrollment has swelled to 947,100 Kentuckians.

Asked what she would write in an anniversary card to Medicaid, healthcare advocate Sheila Schuster said "congratulations, keep on going." She says with an extra 400,00 Kentuckians recently qualified for the program, the key is to make sure they tap into preventive care - things like getting a colonoscopy or mammogram.

"Those are the things that work to keep people healthy," says Schuster. "We've got hundreds of thousands of Kentuckians who have never really thought about their health except how sick they are."

Medicaid expansion has become a wedge issue in the governor's race, with the candidates differing on whether or not to roll back expansion.

But, as the 50th anniversary nears, advocates are focusing on the good Medicaid has done, especially for children. An analysis by the Kentucky Center for Economic Policy finds that 44 percent of the births in the state are covered by Medicaid, and 462,000 children get their health care through the program.

The Center's communications director Kenny Colston says that has long-term benefits for kids.

"It's not just health that we are talking about here," says Colston. "It's financial stability and it's economic progress for these children."

Between Medicaid and the state's health insurance program for children, KCHIP, fewer than six percent of Kentucky's kids are now uninsured.

Schuster, with the Action Advocacy Network, says the increased enrollment means most children are getting the immunizations they need, and there are more early diagnoses being made on health and behavioral problems.

"If you can nip those things at the early stages, you can save all of us, not only a lot a lot of money, but you can save that individual and their family a lot of grief and heartache," Schuster.


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On Wednesday, Maryland's legislative session begins in Annapolis - and state lawmakers are facing numerous challenges.

Maryland expects pressure from the incoming Trump administration, which has called for slashing the federal workforce.

In a state where the workforce is among the most dependent on federal employment, those jobs translate into tax dollars for the state.

Brenda Wintrode, state politics reporter at the Baltimore Banner, said that matters - especially as Maryland stares down a nearly $3 billion deficit.

"This is going to probably take up a lot of the oxygen out of the session," said Wintrode. "It's the worst imbalance the state has seen in two decades. The revenues just aren't keeping up with the expenses, and economic growth remains sluggish, even though unemployment is at a record low."

She added that she'll be watching to see what lawmakers decide, whether it's cutting spending or raising taxes. Maryland lawmakers have pre-filed more than 250 bills for the 90 day session.

The deficit will have ripple effects in other areas, including education policy.

Progressive reforms, called the Blueprint for Maryland's Future, were passed in 2021. They include increasing teacher pay, preparation time for teachers and diversity among educators.

Wintrode said the program is ambitious, but costly, at a time when the budget remains unbalanced. Maryland Gov. Wes Moore has said he is willing to pause certain policies, given the budget situation.

"Gov. Moore nodded that he would like to look at some of the most costly portions of the program and see how they can cut back on them," said Wintrode. "And one is this portion of the education reform that would allow teachers more time to plan their classes."

Other bills include support for in vitro fertilization, phone-free classrooms, and consumer protections on automatic renewals.

As the Virginia General Assembly convenes, new legislation protecting working families from harsh debt collection practices is on the table.

With consumer debt at record levels and a recent report from the National Consumer Law Center giving Virginia a "D" rating for its debt exemption laws, advocates are calling for reforms to prevent more families from falling into poverty.

Jay Speer, executive director of the Virginia Poverty Law Center, explained Virginia's current laws leave many vulnerable to devastating financial consequences.

"It just creates a really difficult situation when there are a lot of people in this boat," Speer observed. "You have trouble paying one of your bills, and it goes to judgment. And then, if the laws don't protect your assets, then you just basically get into a downward spiral, and you can't get out of it."

Virginia's wage and bank account garnishment laws have long been criticized for pushing families deeper into poverty. While critics may argue such reforms could hinder creditors, one proposed bill from Del. Phil Hernandez, D-Norfolk, seeks to protect a minimum of $5,000 in family bank accounts from garnishment, ensuring families can cover essential costs like food, housing, and medical care. The General Assembly begins Wednesday.

Another bill by Del. Carrie Coyner, R-Hopewell, seeks to end Virginia's unique policy of 100% wage liens for tax debts, which Speer argued harms individuals, particularly those without legal help.

"They can actually garnish your entire paycheck or put a lien on your paycheck and take 100%, while other creditors can only take 25% or less in the case of when you're not paid very much," Speer explained. "The tax debt can take 100%. So you can only imagine if you suddenly find out you're not going to get any wages at all."

Speer also pointed to Virginia's homestead exemption, which allows homeowners to protect a portion of their property's value from creditors, as another area where the state falls short. While legislation passed in 2024 increased the exemption from $25,000 to $50,000, Speer contended it remains inadequate given today's real estate market.

The Trump administration and some House Republicans, including Rep. James Comer, R-Ky., have floated the idea of privatizing the United States Postal Service.

Experts said operating the agency like a private business could leave Kentucky's rural areas without mail options for essential functions such as receiving checks or paying taxes.

Tyler Offerman, manager of policy initiatives at the Kentucky Equal Justice Center, said privatization would eliminate essential infrastructure in rural counties, noting 54 of the Commonwealth's 120 counties are entirely rural, with no urban center.

"Many parts of Kentucky are not profitable based on some of these companies business models, and they're considered expendable," Offerman explained.

The Postal Service saw $1.8 billion in controllable losses in fiscal year 2024, compared to more than $2 billion the prior year, according to the agency. Supporters of privatization argued mail volume is dwindling and the agency has lost billions of dollars over the past decade.

Similar to how the decline in rural Kentucky hospitals has forced people to travel farther or skip medical care, Offerman pointed out the state's most vulnerable people would have to travel farther for mail service or go without timely delivery and access to information they need to make ends meet.

"I help people in food stamps and WIC, and we've got people that help people with Medicaid," Offerman outlined. "The way that you sign up and you get information around those programs is either the internet or the notices you get in the mail."

Porter McConnell, senior director for Take on Wall Street and founder of the Save the Post Office Coalition, said the agency was designed for the public good in a functioning democracy. She added legislation requiring the agency to break even and poor decisions leaving it behind in the digital age need to be addressed to keep it robust.

"It's a terrible candidate for privatization, because it's a core service that everybody needs and everybody needs to be able to use affordably," McConnell argued. "The consequences would be disastrous."

An April 2024 poll by the Pew Research Center found overall, 72% of Americans have a favorable view of the Postal Service. That number jumps to 76% among Democrats, and dips to 68% among Republicans.