But then Donald Trump got elected. He hasn’t yet been able to fulfill his main promise of repealing all of Obamacare, but under CMS administrator Seema Verma, the White House has been able to work toward slowly a piecemeal destruction, sloughing away the number of people covered when and where possible. A key part of the strategy has been approving more and more conservative-leaning Medicaid program waivers that reduce the number of covered or eligible people. The most prominent of those piecemeal reductions was the unprecedented decision to allow state Medicaid programs to make people have to work in order to qualify.

Kentucky was the first state to have its work requirement waiver approved by CMS, but its program is roughly indicative of the other states that came after it. The regulation only applies to able-bodied non-elderly adults, and requires them to complete 80 hours per month of work or work-related programs. People who meet those requirements also have to pay an income-adjusted premium. Violation of either provision means they can lose coverage for six months. Four other states, including New Hampshire, Arkansas, Kentucky, and Indiana, have had similar work requirements approved by CMS. Seven more states—all of them led by Republicans—have applied.

From their inception, these requirements have garnered significant criticism. Most able-bodied people on Medicaid work, and the program itself is a highly successful work support, keeping potential workers well enough to stay on the job. To the extent that joblessness is even a problem for the people on Medicaid, punitive work requirements don’t work. But what work requirements should do very well is reducing overall spending and enrollees by freezing people—many of whom face unreported disabilities or other barriers to work—out of the program for months at a time.

In Kentucky’s case, district court Judge James Boasberg did not see these effects as a compelling case for work requirements. In fact, he argued that Kentucky’s own projections that it will “reduc[e] its Medicaid population by an estimated 95,000 persons” run counter to the purpose of Medicaid. “At bottom, the record shows that 95,000 people would lose Medicaid coverage, and yet the Secretary paid no attention to that deprivation,” Boasberg wrote. “By doing so, he ‘failed to consider adequately’ a salient purpose of Medicaid and, thus, an important aspect of the problem.”

The decision has clearly displeased Kentucky Republicans, including Governor Matt Bevin, who has issued an executive order claiming the state cannot afford its Medicaid expansion without work requirements and directing the state to dismantle the entire expansion if courts strike down the work-requirements waiver. Bevin doesn’t need the executive order to terminate the program, but the text of the order does indicate that he may wait until the state runs out of appeals in order to strip away the expansion.