LEXINGTON, Ky. – The nonpartisan Congressional Budget Office estimates that 24 million people would lose coverage by 2026 under the American Health Care Act, and almost a half-million Kentuckians are included in that number, according to the Urban Institute.

The American Health Care Act (AHCA) would effectively eliminate the Medicaid expansion and change existing tax credits to be based on age instead of income. That could reduce assistance in paying for coverage by as much as $6,000 a year.

Dustin Pugel, research and policy associate with the Kentucky Center for Economic Policy, says Kentucky has drastically reduced the number of uninsured in the last seven years, and under the House plan, the change will be felt in a big way.

"The states that gained the most have the most to lose, and by several measures, Kentucky has gained the most," he explained. "We've seen one of the largest declines in our rate of uninsured. Our folks are able to get to the doctor better like never before. Many of them are reporting actually having better health already."

The CBO report also highlights the fact that insurers will be able to charge older Americans five times more than their younger counterparts. With potentially fewer people insured, Pugel and others predict insurance pools will be made up of sicker people, driving up the demands on insurers and therefore the cost of insurance. Supporters of the AHCA say they are trying to fix a flawed system.

As it stands, the AHCA also would cap federal payments to a certain dollar amount per Medicaid enrollee starting in 2019. Pugel says Kentucky then would have to make up the difference, or drastically reduce benefits.

"It shifts billions in responsibility to the state, making the state responsible for paying more and more, and having a shrinking pot to be able to do that," he said.

Reducing the affordability and availability of coverage also would mean thousands of Kentuckians suffering from illnesses that require expensive prescription drugs will go untreated, and the amount of uncompensated care for hospitals and doctors will increase.

Pugel says capping what the state can spend per person will make it difficult for the state to respond to outbreaks such as Zika or addressing Kentucky's Opioid addiction epidemic.


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After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.