Medicaid expansion helped Kentucky and other states get more people covered by health insurance, but proposed federal cuts could undo that, a new report found.
“Fragile Progress, Continuing Disparities,” released Wednesday by the Commonwealth Fund, also shows a decline in the number of children getting routine vaccinations against such diseases as measles, mumps and rubella.
Kentucky was among the worst states for vaccinations, with 64% of children having all doses of recommended vaccines. Of its neighbors, Kentucky’s childhood vaccination rates were higher than only Tennessee, where about 63% of children are fully vaccinated. Commonwealth Fund researchers said misinformation about vaccines has caused public trust to decrease.
Researchers also found that from 2013-2023, rates of uninsured individuals across the country fell to a “historic low,” Dr. Joseph Betancourt, the Commonwealth Fund president, said during a Tuesday call.
“The coverage gains can largely be attributed to provisions in the Affordable Care Act that made Medicaid available to more people and that helped many low and middle income people afford the cost of health coverage purchased from federal and state run health insurance marketplaces,” Betancourt said.
The report highlights how Kentucky’s decision to expand Medicaid to more low-income people has increased access to health care.
“In Kentucky, one of the first states to expand Medicaid eligibility, the uninsured rate for people with incomes under 200 percent of poverty ($30,120 for an individual and $62,400 for a family of four) fell by two-thirds between 2013 and 2023, from 38 percent to 12 percent,” the report states. “By contrast, in Tennessee, which has not expanded Medicaid, the uninsured rate for the same group of low-income adults declined by only one-third, from 37 percent to 24 percent.”
Kentucky is inching higher in the report’s health rankings — from 40th among the 50 states in the 2023 report to 37th overall in the 2025 report. The state improved on several measures, including having more people covered by health insurance, fewer people with medical debt in collections and fewer depressed youth not getting treatment.
Meanwhile, Republicans in Congress are pushing to cut Medicaid over the next decade. A proposal that emerged from a U.S. Senate committee Monday makes even deeper cuts than those already approved by the U.S. House of Representatives in a controversial spending and tax package, dubbed the “big, beautiful bill” by President Donald Trump who supports the measure. The federal-state Medicaid program pays for almost 1 in 3 Kentuckians’ health care. Many health advocates are warning the Republican legislation will hurt hospitals and patients.
Is health care affordable, accessible?
The Commonwealth Fund report looks at a variety of measures to rank how well health systems work across the nation. Researchers look at how affordable and accessible health care is, how widespread prevention treatments like vaccinations and screenings are, the prevalence of preventable deaths and more.
The report shows:
- In 2023, 4% of Kentucky children ages 0-18 were uninsured. The national average is 5%.
- In 2023, 8% of Kentucky adults ages 19-64 were uninsured, which is lower than the national average of 11%.
- In 2022, 40% of Kentucky adults hadn’t had a dental visit in the past year. That’s higher than the national average of 36%.
- In 2023, 36% of children did not have all their recommended vaccinations. The national average is 31%.
- In 2022, 70% of Kentucky adults living with substance use disorder did not receive treatment. Nationally, that number is 77%.
- From 2020-2023, the 30-day hospital mortality in Kentucky was 15%, slightly higher than 14% across the U.S.
- In 2022-2023, Kentucky had 117 preventable deaths per 100,000 people, higher than the national rate of 86.
- In 2022, for every 1,000 live births in Kentucky, there were nearly 5.8 baby deaths, slightly higher than the 5.6 national average.
- In 2023, there were nearly 18 suicides for every 100,000 people. The national average is 14. The National Suicide Prevention Lifeline is 988.
- In 2023, Kentucky saw 18 firearm deaths per 100,000 people, which is higher than the national rate of 14.
- In 2022, 16% of Kentucky adults had lost six or more teeth. The national average is 9%.
- In 2023, Kentucky had more diabetic adults get their annual hemoglobin A1c test. That year, 4% of diabetic adults in Kentucky didn’t have the test, which is much better than the national average of 9%.
Betancount said the insights should be a “call to action for policy makers” both federally and at the state level to “make sure everyone in America can get the care they need, no matter who they are, where they live, or how much money they earn.”
“I see patients every week, and I and people across the nation can tell you that there is no substitute for being able to get the care you need when you need it, and the evidence is clear that policies that make health insurance and health care more affordable and accessible work and make a difference for people everywhere every day.”
Even though Kentucky still has a lot of bad health marks, having higher rates of insured people is key to improving health, said Sara R. Collins, a senior scholar and vice president for health care coverage and access and tracking health system performance at The Commonwealth Fund.
“Health insurance coverage is essential in this country,” she said. “One cannot access health care without it, except if you’re very, very wealthy.”
It’s also important to have high quality of coverage, low deductibles, low cost sharing, Collins said.
“We continue to have a lot of people, millions of people, who are underinsured in the country, and there are ways of addressing that, through public policy and changes in insurer behavior,” she said. “But it is really a necessary condition for improving home health system performance.”
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