(HEALTH) November 24, 2016 — People in poverty-stricken Clay County, Kentucky, worry about what will happen to their health care if Gov. Matt Bevin’s and President-elect Trump’s ambitions to overhaul Medicaid proceed.

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.

Next year will likely bring more uncertainty when a Trump administration and a GOP-controlled Congress promise to consider Obamacare’s repeal, including a potential reduction in the associated Medicaid expansion in 31 states and the District of Columbiathat has led to health coverage for an estimated 10 million people.

Kentucky Gov. Matt Bevin, who was elected in 2015, has argued his state can’t afford Medicaid in its current form. Obamacare permitted states to use federal funds to broaden Medicaid eligibility to all adults with incomes at or below 138 percent of the federal poverty level, now $11,880 for individuals. Kentucky’s enrollment has doubledsince late 2013 and today almost a third of its residents are in the program. The Medicaid expansion under Obamacare in Kentucky has led to one of the sharpest drops in any state’s uninsured rate, to 7.5 percent in 2015 from 20 percent two years earlier.

Kentucky’s achievement owed much to the success of its state-run exchange, Kynect, in promoting new coverage options under the health law. Kynect was launched under Bevin’s Democratic predecessor, Steve Beshear, and dismantled by Bevin this year.

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.

Source: In Depressed Rural Kentucky, Worries Mount Over Medicaid Cutbacks