By Harriet Bachner
For several legislative sessions, advocates and the medical community have acknowledged the need to expand Medicaid in Kansas. This expansion is crucial for the health and well-being of low-income individuals and for the economic viability of medical facilities, particularly in rural areas of Kansas (Kelly, 2023; AHK, 2023). The Affordable Care Act (ACA) gave the states the option for expansion, with the decision of the governor and the legislature. Despite this available option, the leaders in the Kansas legislature have not even allowed discussion of the expansion issue. Kansas is one of only 10 states that has not allowed Medicaid expansion even though all the surrounding states to Kansas have expanded Medicaid (KFF, 2023). It has been attempted 5 times to expand Medicaid, but the legislature continues to move the goalposts. In fact, Medicaid expansion was passed by the legislature in 2017 and Governor Brownback vetoed the bill. Currently some legislators continue to oppose the ACA (also known as Obamacare) which seems to connect to their opposition to Kancare expansion. This is the situation now despite Governor Laura Kelly and 80% of Kansans being in favor of Kancare expansion (Kelly, 2023). Thus, Kansas is at an economic and humanitarian disadvantage and loses workers who move to these adjacent states for employment and healthcare.
The Alliance for Healthy Kansas (AHK) has developed a resolution in support of ACA Medicaid expansion which highlights important reasons for expanding Medicaid. AHK emphasized the need to increase the availability of health insurance to low-income people and to maintain the economic survival of hospitals in rural Kansas. The AHK describes how expansion would benefit local governments, the criminal justice system, the behavioral health system, and economic development. The federal government pays 90% and the state pays 10% of the cost of covering the expansion population. Since 2014 health care facilities throughout Kansas have lost approximately 6 billion dollars and states that have expanded Medicaid benefitted from these funds (AHK, 2023). Thus, state and local taxes funding the criminal justice and behavioral health systems and economic development would be offset by savings from expansion (AHK, 2023).
Early in the state Medicaid expansions for low-income adults, the New England Journal of Medicine reported that Medicaid expansion was “significantly associated with reduced mortality, improved coverage, access to care, and increased rates of self-reported “excellent” or “very good health status” (Sommers, B.D., Baicker, K., & Epstein, A.M., 2012, p. 1025). There are an estimated 150,000 low-income, currently uninsured Kansans who, with insurance, would likely experience the same benefits from having access to health care (AHK, 2022).
The AHK (2022, 2023) shows that expansion would benefit those low-income adults in the “coverage gap” which includes those with a family of three with income between $9,447 and $24,860 per year. Those below 38% of the federal poverty level (FPL) for a family of three can receive Medicaid and those between $24,860 (100% FPL) and $99,440 (400% FPL) may receive marketplace subsidies. Thus, Kansans experience very rigid requirements to qualify for Medicaid according to AHK. 75% of people in this gap work, sometimes 2 or 3 jobs, and do not have health insurance through their employment. Other individuals in the gap are providing care for a family member or have some mental disability. These facts defy the contention Kansas Republican legislative leaders convey to Kansans that Medicaid expansion would reinforce those who lack motivation to hold a job.
This gap in coverage also affects local government in costs to policing, criminal justice, and behavioral and mental health systems. Low-income Kansans become more vulnerable and have increased likelihood of being involved in the criminal justice system. Local economic development may be stifled due to the costs to these systems. In addition, private sector employers are jeopardized by having workers who do not have access to health care. The counties in states with Medicaid expansion have experienced 10.4% fewer property crimes, reductions in violent crime, robbery and theft, and assault. Those who are incarcerated are more likely to have mental health and substance use disorders and these individuals often do not have health insurance (AHK, 2023). With Medicaid expansion local governments may have lower policing, fixed costs in jails, and reduced spending in variable per-person costs in jails.
With Medicaid expansion Community Mental Health Centers and Certified Community Behavioral Health Clinics would receive an additional annual $17.9 million and Federally Qualified Health Centers would gain $1 million in funds annually (AHK, 2023). Thus, Medicaid expansion would increase the number of patients that psychiatric hospitals, residential treatment centers, outpatient, day treatment, and mental health facilities could accept and provide treatment.
Another critical aspect of Medicaid expansion not directly linked to access to medical care is economic development. For example, employers would have a healthier, more productive workforce, along with reduced absenteeism. Most Kansas industries employ Kansans who may be eligible for expanded Medicaid because they may not be offered employer sponsored health care plans or are unable to afford the coverage that their employer does offer. The private-sector employers could also save by having reduced contributions to health care plans and fewer tax penalties. The industries that would benefit the most include retail and customer service, health care and social assistance, education, manufacturing, construction, agriculture and forestry, and accommodation and food services (AHK).
Considering the reasons and the evidence that shows significant benefits to the physical and mental health of Kansans, economic growth, and keeping a healthy and productive workforce in Kansas, the question remains: Why won’t Kansas Legislators even initiate discussion of a bill to expand Medicaid? We, as some of the 8 in10 Kansans who support expansion, need to write letters, call our legislators, especially Rep. Hawkins and Sen. Masterson, share this information with local Chambers of Commerce, and tell them to support Kancare expansion.
The statistics and Information provided in this article have been gathered and reported by the Alliance for Healthy Kansas for use by local communities to inform Kansans and local government entities about the benefits and importance of Medicaid expansion in Kansas.
References
Alliance for Healthy Kansas (2023). Resolution supporting ACA Medicaid Expansion: For use by local governments. Handout.
Alliance for Healthy Kansas (2022). Minimizing Kancare coverage loss. Handout.
Kelly, L. (2023, October 4). Presentation by Governor Laura Kelly on Medicaid expansion. Via Christie Hospital, Pittsburg, KS.
KFF (Dec. 1, 2023). Status of state action on the Medicaid expansion decision. Retrieved from http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/
Sommers, B.D., Baicker, K., & Epstein, A.M., (2012). Mortality and access to care among adults after state medicaid expansions. New England Journal of Medicine, 367:1025-1034. doi: 10.1056/NEJMsa1202099
