“We are ready to show America how this can and will be done,” Mr. Bevin said at a news conference in Frankfort. And yet Kentucky’s approach to Medicaid draws from a well-worn playbook, one from which both Republicans and Democrats have drawn to trim the social safety net over the years.

Kentucky was an eager participant in the last big so-called entitlement reform, visited upon the nation’s poor just over two decades ago. Under that 1996 program directed at welfare benefits, the entitlement to federal assistance was replaced by a hodgepodge of programs managed by the states and financed by a fixed dollop of federal cash. Work requirements became the norm. And people got less help.

The number of families in poverty in Kentucky has budged little since then, declining to 116,000 from 132,000. But the number of families getting cash assistance has fallen by two-thirds. Today, the Temporary Assistance for Needy Families program covers only one of five poor families in the state. For a single mother with two children, it provides $262 a month — a third less than it did two decades ago, adjusted for inflation.

And Kentucky is hardly the stingiest state. In 15 states, antipoverty cash benefits reach fewer than 10 percent of the families with children in poverty. In all of them, the change was sold as a way to encourage poor Americans to get off their backsides, get a job and prosper on their own — free of the clutches of the welfare state. Yet though it pushed many poor families into employment, it failed at mitigating their distress: Rarely do such families’ breadwinners earn enough to move out of poverty.

The problem with the latest twist in Republicans’ effort to pare the social safety net is that removing the poor’s health insurance may not just make their life more difficult.

It might kill them.

It is well known by now that health insurance saves lives. A review of recent research in the Annals of Internal Medicine concluded that the odds of dying for non-elderly adults are between 3 and 41 percent higher for the uninsured than for the insured.