Governor’s race could make or break Medicaid expansion



October 16, 2018 - 11:04 AM

Kansas has yet to expand Medicaid. A new governor could change that. CC0 CREATIVE COMMONS /DARKO STOJANOVIC /KCUR.ORG

Few issues split Kansas politics like the Obama-era expansion of Medicaid.

Unlike 33 other states, Kansas still has not expanded its Medicaid program under the Affordable Care Act.  Expanding Medicaid would pay for the health care of thousands of people who don’t currently meet the program’s stringent eligibility requirements.

The state’s Medicaid program, known as KanCare, pays for the health care of 400,000 low-income Kansans — mostly children, pregnant women, and elderly or disabled citizens.  It costs the state more than $3 billion a year.

Currently, KanCare doesn’t cover people who fall into the so-called “coverage gap.”  Their incomes are too high to pass the state’s stringent Medicaid eligibility guidelines, but they make too little money to qualify for the Affordable Care Act’s subsidized insurance premiums.

Those benefits are only available to households that make over 138 percent of the federal poverty level — $25,100 for a family of four.  Some do meet income requirements, but they don’t meet another eligibility guideline, like being disabled, under 19, elderly or pregnant.

In Kansas, 150,000 people fall into that gap.

They’re not eligible for Medicaid, and if they apply for health insurance through the federal marketplace, they’re on their own with no government financial assistance.

Expansion would allow them to apply for coverage through KanCare, as long as their household incomes are below 138 percent of the poverty line, and regardless of whether they meet other eligibility requirements.

Supporters say that could be a lifeline for the state’s most vulnerable residents and helps them avoid emergency room visits by giving them access to more suitable care.

“This gives them access to not just health care, but the right care,” said Cindy Samuelson, a vice president of the Kansas Hospital Association.

The issue has long been under debate.

Democrats and some moderate Republicans have argued for years that expansion would bring more health care dollars into the state economy, creating medical jobs and filling a coverage void that could keep the doors open at small, rural hospitals.

Conservatives continue to resist. They argue expansion squanders federal tax dollars and saddles Kansas taxpayers with an obligation to pay for an increasingly large share of that government health insurance.

“As much as we all want to try to provide a solid safety net for people, we have to weigh that against other priorities in state government,” said James Franko, vice president and policy director of the Kansas Policy Institute.

A bipartisan majority in the Legislature voted in 2017 for expanding Medicaid, but then-Gov. Sam Brownback vetoed it.  Brownback, a Republican, said in a statement that he opposed the bill in part because of its cost and because it didn’t require recipients to work.

Gov. Jeff Colyer, also a Republican, served as lieutenant governor in Brownback’s administration and has followed his lead in supporting Medicaid work requirements and opposing the Affordable Care Act — including expansion.

The 2018 governor’s race will decide the issue in Kansas for years to come.

Medicaid certainly won’t expand if Republican Secretary of State Kris Kobach wins the race.  Democratic state Sen. Laura Kelly has promised to sign a bill approving expansion in her first year. Independent Greg Orman also says he supports expansion.

“The governor is extremely important,” said April Holman, executive director of the Alliance for a Healthy Kansas, who advocates for expansion. “If we don’t have a governor who supports expansion, we probably would have a similar result to what we have had in the past.”