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Jan. 6, 2014
TOPEKA The political dynamics are a bit different in Kansas than in Missouri, but in both states supporters of expanded Medicaid programs are taking the same tack in hopes of persuading reluctant Republican policymakers to eliminate the so-called "Medicaid gap" that is leaving more than 340,000 low-income Kansans and Missourians without health insurance.
The Affordable Care Act, as written, would have expanded Medicaid in every state, including Missouri and Kansas where the eligibility restrictions are relatively tight. But the U.S. Supreme Court in 2012 ruled that expansion was a decision for each state to make on its own.
Kansas and Missouri are among the 24 states that so far have chosen against broadening the program, despite entreaties from hospitals, doctors, consumer advocates and others.
Kansas, led by Republican Gov. Sam Brownback and a GOP-dominated Legislature, is expected to reconsider the issue in the weeks ahead.
In Missouri, Gov. Jay Nixon, a Democrat, has been urging the Republican-controlled General Assembly to do the same.
In this package of stories, KHI News Service looks at the latest developments in each state as their legislatures prepare to convene 2014 sessions.
Also included are profiles of families in each state that earn too much to qualify for Medicaid as it is currently configured, but too little for the subsidies intended to help people (earning between 100 percent and 400 percent of federal poverty guidelines) buy private health coverage through the new marketplaces created by the Affordable Care Act.
Photo courtesy Kansas Hospital Association
Many uninsured Kansans who Congress assumed would get coverage under the health reform law are instead falling in to what is being called the “Medicaid gap.”
They make too much money or don’t meet other criteria to qualify for the state’s Medicaid program – called KanCare – but don’t earn enough to be eligible for federal tax credits to offset the cost of private insurance. Those credits are available only to people with incomes between 100 percent and 400 percent of federal poverty guidelines. The federal poverty level is $11,490 a year for an individual and $19,530 for a family of three.
As many as an estimated 85,000 uninsured Kansans fall in the eligibility gap.
Kathleen Christian is a remarkably healthy 63-year-old. She has no chronic conditions and rarely sees the doctor for anything other than preventive care.
Even so, she said she had been looking forward to getting health insurance under the Affordable Care Act, after having been without coverage since she was laid off in 2009.
But last month, Christian learned she would not be able to get coverage after all.
KHI News Service file photo
A year ago, Missouri had a Democrat governor who strongly supported expanding the state’s Medicaid program in line with the original intent of the Affordable Care Act but a Republican legislature that was foursquare against the idea.
Those political dynamics appear unchanged as the General Assembly prepares to convene Wednesday for this year’s session.
But Medicaid expansions advocates said they are hoping that the differing factions might find common ground and extend coverage to thousands of uninsured Missourians, especially after three legislative committees spent the summer and fall studying ways to improve the state-federal medical program for the poor.
Jeanette Pettijohn is studying to be a special education teacher.
The 32-year-old Kansas City, Mo. woman attends classes at Metropolitan Community College-Penn Valley.
A divorced mother of four young children, she has a work-study job on campus that pays about $6,500 a year, which is still too much for her to qualify for Medicaid in Missouri, though the program covers her children.
She also is far below the earnings threshold ($27,570 for a family of five) that would qualify her for subsidized health insurance in the marketplace established by the federal health reform law.
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