Kansas\' Refusal To Expand Medicaid Has Cost Hospitals More Than $1B

Kansas’ rejection of Medicaid expansion has cost the state more than $1 billion, according to the association that represents the state’s hospitals.

“This 10-figure sum represents a loss of nearly 11 Kansas taxpayer dollars every second since Jan. 1, 2014 — funds that go to the federal government to be spent in other states for Medicaid expansion,” the Kansas Hospital Association, which keeps a running total of the amount on its website, said in a news release issued Monday.

Since the start of 2014, when the main provisions of the Affordable Care Act took effect, 31 states and the District of Columbia have expanded Medicaid eligibility to all adults earning up to 138 percent of the federal poverty level, according to the Kaiser Family Foundation.

The annual income limits in expansion states are $16,242 for an individual and $33,465 for a family of four. In Kansas, only adults with dependent children are eligible for KanCare, the state’s privatized Medicaid program, and then only if their incomes are below 28% of the poverty level, which for a family of four is $9,216.

Hospital officials say Medicaid expansion would provide coverage to approximately 150,000 Kansans, many of whom are now uninsured, and generate additional federal dollars for providers hit hard by reductions in Medicare reimbursements triggered by the ACA and a budget-cutting formula that congressional conservatives demanded.

But those arguments have so far failed to move the needle on the issue. So, this year, hoping to gain some traction, KHA introduced what its Bridge to a Healthy Kansas plan. It's modeled after the so-called “red state” expansion plan crafted by conservative Republican Gov. Mike Pence in Indiana. 

"The time has come for Kansas to move forward with a unique, Kansas based solution that uses federal funding to bridge our state's health care coverage gap," said Cindy Samuelson, a KHA spokesperson. "The Bridge to a Healthy Kansas is a fiscally responsible way to make health care affordable for more Kansans."

The KHA proposal, like the Indiana plan, requires beneficiaries to pay a portion of their premiums and suspends coverage for those who fail to pay. Some Republicans in the Kansas Legislature who had opposed expansion have said they’re open to considering KHA’s new plan. But Gov. Sam Brownback and Republican legislative leaders remain opposed and appear determined to keep the issue from coming to a vote.

Over the weekend, the state committee of the Kansas Republican Party unanimously passed a resolution opposing expansion. It says that so-called “red state” expansion plans like Indiana’s merely “offer window dressing to disguise the expansion of Obamacare.” Because the federal government won’t allow states to require that Medicaid beneficiaries work, the resolution says even the expansion plans adopted in Republican-controlled states do little to promote “personal responsibility and self-reliance.”

Noting that enrollment has been higher than anticipated in expansion states, opponents also say they don't believe the federal government can afford to permanently shoulder 90% of expansion's costs as the ACA requires it to do. 

At the halfway point of the legislative session, no hearings have been scheduled on KanCare expansion and two attempts to force floor votes on the KHA proposal have failed.  

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