The EconomistJanuary 20th 2018 United States 3112 of dependency and complacency”.
Yet it is not true that most, or even many
Medicaid claimants are shirkers. Just 36%
are non-disabled adults, and 60% ofthat
group already work. Those who are not
working and not disabled do not seem to
be lying about in hammocks: 36% say they
are ill, 30% take care of a family member,
15% are in college, and so on. At most 10%, or
1.4% of all enrollees, could be said to lack
any good reason for not working. “I don’t
need added pressure to get a job, the pres-
sure to survive is already enough,” says Ta-
jah McQueen, a caterer in Louisville who
lost her job on December 28th and applied
for Medicaid soon afterwards. She already
pays $400 a month for her student loans,
$2,000 for her mortgage and takes care of a
two-year-old daughter.
To weed out malingerers, Kentucky is
proposing to build an unwieldy adminis-
trative apparatus. This bureaucratic levia-
than will enforce regulations seemingly
designed to catch out the maximum num-
ber of recipients. The state will begin by
collecting premiums, capped at $15 per
month. This would seem minimal, except
that to qualify for Medicaid as a single per-
son requires an annual income of less than
$16,640. For Kentuckians who gained cov-
erage under the Medicaid expansion, non-
payment of these premiums for two
months results in a six-month lockout on
coverage—only to be restored after pay-
ment and attendance of a “health-literacy”
class. When Indiana set up a similar pro-
gramme, 55% of people had missed pay-
ments within the first 21 months, leaving
them with inferiorcoverage ornone at all.
Participants must also document their
work on “at least” a monthly basis. Be-
cause most working Medicaid recipients
are in low-paying industries with erratic
scheduling, such as retailing, agriculture or
construction, they may not fulfil the 20-
hour requirement in a week. Someone
who temporarily makes too much mon-
ey—more than $320 a week as a single per-
son—may risk getting the boot.
Of the ten rural counties in the country
with the highest share of adults enrolled in
Medicaid, six are in Kentucky. These areas
are also the Trumpiest. There is a remark-
ably strong correlation in Kentucky be-
tween Medicaid enrolment and support
for Republicans (see chart). During the
1990s, racial animus, especially the notion
that lazy blacks were crowding the welfare
rolls, was shown to be especially powerful
in shaping attitudes to the safety net. Yet
the people most likely to suffer from these
new efforts at reform are the poor whites
who helped send President Donald Trump
to the White House. 7#magaSources: Kentucky Cabinet for Health
and Family Services; US Census BureauUnited States, support for Donald Trump and
Medicaid enrolment in Kentucky, by countyTrump support, % of votes in 2016 election^0255075100025
Medicaid enrolment, Dec 2017, % of population50 75T
RADITION dictates that bad children
get coal in their Christmas stockings.
But the elaborate Christmas displayin the
headquarters of Murray Energy Corpora-
tion, America’sbiggest privatelyowned
coal firm, suggestsotherwise. At its centre
are two cherubic children pulling a wagon
loaded with coal, and looking pleased
with their haul. The other distinctive fea-
ture in the building’s lobby is a plethora of
pictures featuring Bob Murray, the com-
pany’s founder and boss, with President
Donald Trump. Mr Murray was a vocal and
generous backer of Mr Trump; today he has
the president’s ear. He sent the administra-
tion an “Action Plan” with 16 detailed poli-cy requests, manyof which the adminis-
tration is on track to fulfil. Mr Trump
nominated Andrew Wheeler, a lobbyist
for Murray Energy, to the number-two po-
sition at the Environmental Protection
Agency (EPA). A few weeks after a meeting
with Mr Murray, Rick Perry, the energy sec-
retary, ordered a study that became the ba-
sis for his proposal to subsidise coal and
nuclear plants.
Mr Murray’s clout may stem in part
from the hundreds of thousands of dollars
he has given to Mr Trump and his inaugu-
rations committee. But he was pushing on
an open door. Among the few consistent
themes from this most inconsistentof pres-idents has been a fondness for coal and
steel, where brawny men do essential
work and are threatened not by shifting
economics, but by greenies and weenies
who want to shutthem down. Mr Trump
and Mr Murray both want environmental
rules rolled back—Mr Murray because it
would be good for his bottom line, and Mr
Trump because a second consistent aim of
his presidency is to reverse anything done
by Barack Obama. Itis doubtful whether
policy shifts alone could revive coal min-
ing, but the attempt to do so says much
about how vested interests operate in this
administration.
Mr Trump played a hard-nosed busi-
nessman on TV, but Mr Murray is the real
thing. When he was nine, his father was in-
jured in a mining accident and left para-
lysed. Soon afterwards he began mowing
neighbours’ lawns to support his family,
and then went down the mines himself
several years later. He broke his neck,
twice. Gradually he worked his way up the
ladder of the North American Coal Corpo-
ration, becoming the company’s boss in- Forced out in 1987, Mr Murray bought
a mine in eastern Ohio, and then spent the
next two decades snapping up others. To-
day Murray Energy owns 12 mines and
manages another four, as well as transport
terminals, barges, oil-and-gas wells and
factories that make mining equipment.
These days coal barons are like newspa-
per barons: however rich and successful,
they are shackled to a dying industry. Mr
Murray contends that the declining use of
coal—today it generates 30% of America’s
electricity, down from more than half in
2000—imperils energy security. Only coal
and nuclear power, he argues, can provide
a “reliable, resilient, secure electric power
grid”. If coal falls below its current level of
30%, he warns, “the lights will go out and
CoalMinding Grandma
ST CLAIRSVILLE, OHIO
Bob Murray, the coal baron with the president’s earMr Murray in his element