For more than a decade, despite the support of Kansans for expanding Medicaid, the Kansas Legislature has repeatedly voted against it. As legislators prepare to head back to the capitol in January for the 2025 session, certainly the merits of Medicaid Expansion will be discussed, yet again.
It’s been 11 years since the expansion of Medicaid became an option for states under the Affordable Care Act or ObamaCare. It’s been so long that some of you may not remember what the dispute is all about and why Medicaid Expansion means a lot to so many and so little to the majority of Kansas’ legislators.
Back to the Beginning of Obamacare
When it was approved in 2010, the Affordable Care Act only covered individuals and families with an income equal to or above the Federal poverty line (FPL). The idea was that people below this level might have trouble paying the monthly premiums under the ACA.
For those individuals, the program proposed the expansion of Medicaid coverage by the states with the Federal government offering to pay up to 90% of the cost.
In Kansas, the existing Medicaid program (known as KanCare) already covers low-income children, pregnant women, elderly Kansans and people with disabilities. However, non-disabled, childless adults are not eligible for Medicaid.
To qualify for Medicaid, non-disabled parents must earn less than 33% of the federal poverty level, or about $8,520 annually for a single mother with two children. So, individuals who earn more than 33% of the federal poverty level and less than 100% of the federal poverty level fall into what is called the Medicaid gap. They’re too rich to qualify for Medicaid and too poor to qualify for ACA.
Individuals in the Gap, Plus
ACA planned for the individuals in the coverage gap to be covered by the state’s expansion of Medicaid. In addition, ACA called for the expansion of Medicaid not just to the 100However, the Kansas Legislature voted not to expand Medicare, despite the Federal government’s agreement to cover 90% of the cost.
In Kansas, there are about 152,000 adults who could qualify for health insurance coverage if KanCare was expanded. Estimate project Medicaid expansion would add 95,000 adults aged 19‒64 and nearly 50,000 children—to the KanCare rolls.
To date, all but 10 states have voted to expand Medicaid.
Support for Medicaid Expansion
Support for Medicaid expansion in Kansas remains high, according to a new survey by the Docking Institute of Public Affairs at Fort Hays State University.
More than 72% of respondents to the Kansas Speaks survey said they support expanding Medicaid, up slightly from last year. That includes over 63% of Republicans and nearly 90% of Democrats.
“It’s a little remarkable that there’s been such a constant drumbeat of support,” for expansion, said Docking Institute director Brett Zollinger.
According to the Kansas Health Institute, Medicaid expansion would allow an estimated 152,000 more low-income Kansans to receive coverage under the government healthcare program. Analysts say many people who would be covered by expansion are working jobs that don’t offer health insurance.
There was a slight increase in the portion of respondents who think that the people who would obtain coverage through Medicaid expansion deserve the benefit.
The survey also found that there was a more than 11% increase in the portion of Kansans who agreed that expanding Medicaid would help rural hospitals remain in business by reducing uncompensated care costs for hospitals, especially in rural areas.
Several rural hospitals in the state have closed in recent years, including closures last year in Fort Scott and Herington, which have threatened timely access to emergency medical care.
Opposition to Medicaid Expansion
Opposition to Medicaid expansion in Kansas among members of the state legislature often stems from a mix of ideological, financial, and political concerns.
Many conservative legislators believe in limited government and prefer market-based solutions. They oppose an expanded role for government in healthcare. They favor market-based solutions to healthcare issues rather than government-funded programs.
Their financial concerns include the state’s responsibility for 10% of expansion costs, which critics argue could strain the budget and divert funds from other priorities. There is also fear that federal funding might decrease in the future, leaving Kansas to cover more expenses.
Some lawmakers advocate for work requirements for Medicaid recipients, arguing expansion without such provisions discourages employment. Critics sometimes claim that the current Medicaid program sufficiently covers the most vulnerable populations and that expanding it would provide benefits to able-bodied adults who could potentially secure private insurance.
Political resistance to the Affordable Care Act (ACA), of which Medicaid expansion is a component, also plays a role, as does lobbying from conservative groups, who frame it as a step toward socialized medicine.
While proponents argue that Medicaid expansion could help struggling rural hospitals stay open by reducing uncompensated care costs, opponents counter that expansion does not guarantee financial stability for these facilities.
The Debate Continues
In 2017, as the Kansas Legislature headed back to Topeka, Pres. Donald Trump had just been elected as had a large number of Republicans who campaigned on a platform to overturn the Affordable Care Act. Then Kansas Gov. Sam Brownback, who opposed expansion, said it would be foolish to expand Medicaid
given the Republican’s plan to repeal Obamacare.
That year, Rep. Susan Concannon, who introduced a bill to Expand Medicaid on behalf of the Kansas Hospital Association, countered it would be foolish not to take advantage of claiming billions of additional federal dollars and covering more than 100,000 additional low-income Kansans.
That year, the Republicans failed to repeal Obamacare, and since then, their very vocal opposition to the Affordable Care Act has diminished as American’s support and use of the program has expanded.
What hasn’t changed is the annual loss of Federal financial support that could help cover 100,000 or more of Kansas’ most vulnerable citizens or Kansas’ Republicans’ opposition to Medicaid Expansion, even as other legislatures across the country see the light and help strengthen the health of all residents in
The health of citizens in states that have expanded Medicaid generally shows better overall health metrics and reduced health disparities, while non-expansion states struggle with higher uninsured rates and worse health outcomes, particularly among vulnerable populations.
