On January 22, 2018 the New York Times published an article by Austin Frakt detailing the new plan that the state of Kentucky has for Medicaid coverage.

The article explains that if someone lives in Kentucky and does not reach the state's work requirements to receive Medicaid that person can receive Medicaid if they pass health and financial literacy courses and tests.

It is not yet known what information will be in these courses or on these tests, but a manager with Kentucky Health said that household budgeting, weight management, and managing chronic diseases would be covered.

While this kind of information is important and, unfortunately, a large portion of American citizens are lacking knowledge it can be assumed that these courses would necessitate a level of general literacy to pass. A certain reading level and knowledge of numbers to understand the course material. And if someone does not have that level reading level or understanding of math they don't get healthcare. And what if their condition impedes them from this reading or math level?

It might be an extreme proposition but in doing this is Kentucky deciding that the lesser educated are not a priority to the state government?

Now there is proof that health literacy is lacking and in 2003 the National Assesment of Adult Literacy (NAAL) found that just 60 percent of Medicaid recipients had a "basic" or "below basic" level of health literacy, Medicare recipients had about the same level, and privately ensured people tend to score higher but even then only a minority scored "proficient". Privately insured people tend to be younger and have a higher education and so have somewhat of an advantage.

Frakt also brought up a statement made by Harold Pollack, a professor at the University of Chicago who has published work on basic financial education, “If these topics are taught at all in primary education, they certainly aren’t addressed consistently or in an evidence-based way, but singling out the Medicaid population for classes as a condition for access to insurance suggests that shrinking and stigmatizing the program, not literacy, is the goal.”

Pollack is suggesting that by singling out this particular population Kentucky is trying to force the Medicaid program to become smaller and smaller. And that educating people on health and finance and ensuring them through Medicaid is not the goal.

While it is found that teaching health and finance literacy in school, middle or high school settings, the information does seem to stick and the students are more informed on the subjects. And most agree that health and finance literacy is something that needs to be taught because much of America lacks an understanding.

But is this the way to do it. Ration healthcare to the unemployed who have 'earned' it? Should people have to 'earn' health insurance? Is that any different than saying that they have to earn the right to live?