LOUISVILLE, Ky. — U.S. Rep. Andy Barr said Tuesday that Kentucky's efforts to put work requirements on many Medicaid recipients would be in their best interests, leading them toward self-sufficiency and away from reliance on the government health insurance program.

That stance could elevate health care as a flashpoint in a congressional race that Democrats think gives them their best chance to gain a seat this year in a state that has trended heavily toward Republicans. It puts the GOP incumbent at odds with his opponent in Kentucky's 6th District, Democrat Amy McGrath, who says she values encouraging people to work but cautions that a work requirement shouldn't be used punitively.

Barr said in a phone interview that he supports giving state leaders the flexibility to shape Medicaid programs to meet their states' health needs and budgets.

Fallout from Kentucky's efforts to revamp its Medicaid program intensified in recent days when Republican Gov. Matt Bevin's administration said dental and vision coverage will be cut for as many as 460,000 Kentuckians after his overhaul plan — which included the work requirement — was rejected in court.

Asked about Bevin's action, Barr said: "I have no reaction. It's a state decision and I'm a federal lawmaker. My job, the way I look at it, is to support a Medicaid program that allows every state ... to tailor their Medicaid programs according to the state-based policymakers' decisions."

Barr's muted response contrasted sharply with McGrath's biting criticism.

"Gov. Bevin's obvious goal is to take health care away from Kentuckians," she said. "He tried to do it by instituting his unconstitutional work requirements. When that didn't work, he's just going through with taking health care away any way he can."

Medicaid is the joint state and federal health insurance program for the poor and disabled.

Kentucky was on the verge of starting to implement its Medicaid changes until a federal judge blocked the plan last week.

President Donald Trump's administration gave Kentucky permission to require "able-bodied" adults to have at least 80 hours each month of "community engagement" to be eligible for Medicaid benefits. That includes working at a job, going to school, taking a job-training course or community service. It was the first time the federal government had allowed a work requirement for Medicaid benefits.

Barr — who represents a district covering Kentucky's bluegrass and east-central regions — spoke favorably of work requirements Tuesday and said the judge's rejection of Kentucky's plan was "not a final result," predicting it will likely be out-of-step with other courts.

"Allowing states to require work or job training for able-bodied, work-capable adults — non-elderly, non-disabled people — is in the best interest of those individuals," Barr said. "Because it will help them achieve self-sufficiency and work-based health insurance, which is much more generous for them and their families than Medicaid, which is effectively a waiting line. It's government-run health care ... it's rationed health care."

The federal health care law championed by former President Barack Obama gave states the option of expanding Medicaid coverage to able-bodied adults. Kentucky, under former Democratic Gov. Steve Beshear, was one of 32 states that did so.

McGrath said that was a "smart decision," saying it significantly lowered Kentucky's rate of uninsured residents.

Asked her stance on adding work requirements for many Medicaid recipients, she replied: "I value encouraging people to work, if they are able, but I fail to see why we are linking that to having health care. We can't punish those who need assistance as a cruel way to cut the state budget."

Bevin's office had said it expected the Medicaid changes to save taxpayers more than $300 million over the next five years. Administration officials said the new rules would apply to about 350,000 Kentuckians, about half of whom already have jobs. They estimated as many as 95,000 people could lose their Medicaid benefits, either by not complying with the new rules or by getting jobs that pay too much for them to be eligible.

Health care looms as a crucial issue in the fall campaign.

Barr supports repealing the Affordable Care Act, referred to by many as "Obamacare," and replacing it with a system that includes refundable tax credits to help low-income people purchase health insurance. McGrath backs the health care law and has said she favors a public health insurance option as part of the ACA. She also supports expanded access to Medicare for people 55 and older.