Kansas Medicaid Backers Must Change Tact To Achieve Expansion

One of the leading advocates for Medicaid expansion in Kansas says it’s time to change tactics.

This week Alaska became the 30th state to expand Medicaid under the federal Affordable Care Act. Kansas is one of the remaining states where Republican legislators and governors remain resistant.

Sheldon Weisgrau, director of the Health Reform Resource Project for the Kansas Association for the Medically Underserved, told a group attending the 2015 Kansas Conference on Poverty on Thursday that the lack of progress calls for a new strategy.

“We all need to figure out how to advocate on this issue,” Weisgrau said. “Obviously what we’ve been doing isn’t working.”

He said focusing on numbers — like the 90,000 uninsured Kansans who would gain coverage through the expansion and the billions of federal dollars it would funnel into Kansas — has not persuaded lawmakers.

Moving forward, his focus will be on reaching them emotionally, by sharing personal stories from Kansans who can’t pay for medical care that they need.

Weisgrau noted that the group of about 20 he was speaking to at the conference all work with people in poverty, many of whom might fall into the ACA “coverage gap” because they’re too poor for private insurance subsidies but not eligible for Medicaid.

He asked if the people they work with know that they could get Medicaid coverage if the Legislature accepts expansion.

“A lot of you are shaking your heads,” Weisgrau said. “That’s problem No. 1.”

Navigating the system

One person in the audience, Steve Henoch, said the clients he works with know if they fall into the gap because telling them is part of his job.

Henoch is a navigator for the healthcare.gov online exchange that the uninsured can use to purchase private insurance with federal subsidies. He works out of Salina Family Healthcare.

He said that, especially in the first year of the ACA, he had a number of people who desperately needed health care come in and fill out the online application with him, only to find out that they made too little money to qualify for subsidies.

Then he had to tell them there was simply no health insurance they could afford.

“It’s horrible,” Henoch said.

Most of them did not know who their state representatives were or where those officials stood on the issue of Medicaid expansion, he said.

“Usually they didn’t have any idea this was going on,” Henoch said. “They didn’t even know about the expansion.”

Weisgrau said those are the type of people Medicaid expansion advocates need to get registered to vote and politically engaged.

He said a website to collect their stories soon will be live.

Cost remains a factor

Opponents of Medicaid expansion have objected to several issues, including its cost, which Weisgrau said will continue to be a sticking point given the state’s beleaguered budget.

It is likely too late for the state to take advantage of the last year of full federal funding for expansion in 2016. After that, the cost-sharing will gradually drop to 90 percent federal and 10 percent state.

Weisgrau said that means expansion would cost about $800 million in state money between now and 2025. But he said that’s a small fraction of what the state is slated to spend in that same time period on subsidies to help lure corporations to Kansas, while the Medicaid expansion would draw $8.5 billion in federal funds that would create economic stimulus and jobs throughout the healthcare industry.

Additionally, he said, getting Medicaid coverage for more people would take financial pressure off other state and local programs that serve the uninsured.

“Every single state that has expanded Medicaid has seen reduced spending on the uninsured in other parts of their state budgets,” Weisgrau said.

Weisgrau agreed with one audience member who said some legislators will continue to oppose anything connected to President Barack Obama, regardless of numbers or emotional stories.

Weisgrau encouraged advocates to rebrand the issue as “KanCare expansion” rather than “Medicaid expansion” to tie it to Republican Gov. Sam Brownback’s signature health care initiative rather than Obama’s.

He said that while Medicaid coverage is far from perfect, it is effective at limiting out-of-pocket costs for hospital stays and preventing medical bankruptcies.

“One of the things we know about Medicaid is that it — like health insurance is supposed to — provides financial security,” Weisgrau said.

The KHI News Service is an editorially independent initiative of the Kansas Health Institute.