KHI News Service

Kansas hospitals leading new push for Medicaid expansion

But winning over Republicans expected to be unlikely without help from governor

By Jim McLean | January 06, 2014

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, according to researchers at the Kansas Health Institute, a nonprofit policy and research organization that includes the editorially independent KHI News Service.

These Kansans have incomes that are 33 percent or more of the federal poverty threshold — $6,445 for a family of three — but below 100 percent of poverty guidelines.

Katelyn Winrick, a 26-year-old nursing student from Topeka, recently discovered she falls in the gap.

She had come to the Topeka Shawnee County Public Library to get help purchasing health insurance on But after entering information about the income she earns from a part-time job, Winrick and the navigator assisting her concluded she didn’t make enough to qualify for a federal tax credit. That and the fact that she would have been eligible for Medicaid if Kansas officials had opted to expand the program as originally intended by the authors of the Affordable Care Act were “real eye openers,” Winrick said.

“I’m going to school and that really would have helped me given my income situation,” she said.

‘The only priority’

The Affordable Care Act, as signed into law in 2010, was written to include a nationwide expansion of Medicaid to cover everyone earning up to 133 percent of the federal poverty level — $15,282 for an individual and $25,975 for a family of three. But the 2012 U.S. Supreme Court decision that upheld the law held that Medicaid expansion was an option for each state to decide. Policy makers in Kansas and 23 other Republican dominated states so far have chosen against expansion.

The Kansas Hospital Association and a growing coalition of more than 50 organizations are preparing to push Gov. Sam Brownback and leaders in the Republican-controlled Legislature to change their minds and broaden the program.

Sean Gatewood

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“It is the only priority,” said Sean Gatewood, the interim director of the Kansas Medicaid Access Coalition. “All we care about is getting the state to accept the money and to cover more Kansans.”

An analysis done for the hospital association concluded that expanding Medicaid eligibility starting this year would have injected another $3 billion into the state economy and create 4,000 jobs by 2020.

Rejecting expansion will cost Kansas an estimated $5.3 billion in federal aid between 2013 and 2022, according to a report released last summer by the Kaiser Family Foundation.

In an effort to get the issue of expansion back in front of legislators, the hospital association has hired Mike Leavitt, former secretary of the U.S. Department of Health and Human Services, to help it craft an alternative plan — perhaps similar to those being advanced by Republican governors in Iowa, Pennsylvania, Tennessee and Michigan, which would use federal Medicaid dollars to help low-income people buy private coverage.

Photo courtesy Kansas Hospital Association

Tom Bell, president and CEO of the Kansas Hospital Association.

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“We ought to as a state be having a conversation about whether we can come up with a plan like that and the reality is that conversation just hasn’t happened yet,” said Tom Bell, the hospital association’s chief executive.

Bell said he hopes that Leavitt, a Republican who served under President George W. Bush’s and is a former Utah governor, can help convince Kansas Republicans to seriously consider Medicaid expansion options.

“My sense is that he (Leavitt) is somebody that’s not a big fan of the Affordable Care Act or Obamacare, but he also knows that whether we like it or not we’re all in the implementation business right now,” Bell said.

Rep. Jim Ward, a Wichita Democrat, who pushed unsuccessfully last year for Medicaid expansion, said he welcomes the attempt to revive the policy debate by focusing on an approach that relies more on private-sector insurance.

“If that helps some of our more extreme conservative folks to support it, I’m OK with that,” Ward said. “I’m all for anything that gets us an opportunity to participate in Medicaid expansion.”

Time will tell whether the new approach will be the game changer Bell and others seek.

Rep. Ron Ryckman Jr., R-Olathe

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Governor's leadership

Rep. Ron Ryckman Jr., a conservative Republican from Olathe and chairman of the House Social Services Budget Committee, said any sort of Medicaid expansion likely would be a tough sell unless Gov. Brownback changes his mind and decides to play an active role in the debate.

“I haven’t spent a lot of time researching what other states have done, but it seems to me that the governor has taken the lead in states that have expanded (Medicaid) or that are having these discussions,” Ryckman Jr. said.

Last year, Brownback did not explicitly rule out expansion. But he expressed reservations about the potential cost to the state and said it would be up to the Legislature. The Legislature subsequently passed a budget proviso saying the state could not expand its Medicaid program without explicit legislative support.

Brownback officials recently said they continue to study what other states are doing.

Bell said he was optimistic the governor eventually would support some form of expansion.

"From the very beginning, Gov. Brownback has been very interested in taking a hard look at this — and I think partly because of his concern for those who are less fortunate. I've heard him talk about that often, and I do think that it's a factor for him. There are lots of factors, I'm sure, but I think how we treat those who are the least fortunate among us is something that's important to the governor — very important to him."

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KHI News Service coverage of Medicaid expansion

Medicaid Access Coalition launches online "ticker" showing foregone federal dollars (2/13/14)
→ KHI report: Nearly 182,000 Kansans in the ‘Eligibility Gap’ (1/11/14)
House speaker says Medicaid expansion is "up to the governor" (1/10/14)
KS Senate president says Medicaid expansion unlikely to gain approval this session (1/7/14)
Profiles of the coverage gap: Kathleen Christian (1/6/14)
Efforts continue to expand Medicaid in Kansas and Missouri (1/6/14)
Hospital association hires former Bush HHS secretary to help craft a plan Kansas Republicans might support (12/23/13)
Iowa wins approval to expand Medicaid by using federal funds to buy private insurance (12/11/13)
White House officials hold call to urge Medicaid expansion in Kansas (11/21/13)
Republican governor talks up plan to expand Medicaid — his way (10/28/13)
Challenger says Brownback owes voters a decision on Medicaid expansion (10/22/13)
Nearly 5.2M Americans fall in coverage gap in states not expanding Medicaid (10/16/13)
Sebelius: Feds flexible on how states expand Medicaid (9/22/13)
Sebelius says Kansas and Missouri are missing the boat on Medicaid expansion (9/20/13)
Medicaid expansion coalition finds strength in numbers (9/17/13)
Republican Gov. Corbett proposes expanding Pennsylvania Medicaid (9/16/13)
Kansas lawmakers urged to consider Medicaid expansion by Wesley CEO (8/29/13)
Estimating maneuver could help more people gain from Obamacare: How the poor might qualify for Affordable Care Act subsidies in states that don't expand Medicaid (8/12/13)
Report: States not expanding Medicaid stand to benefit most from doing so (7/18/13)
CMS won’t penalize hospitals in states slow to expand Medicaid (5/14/13)
Insurer Centene: We can do Arkansas-style Medicaid (5/14/13)
The Arkansas Medicaid Model: What you need to know about the 'private option' (5/2/13)
Nothing to be done about coverage gap in states not expanding Medicaid, feds say (4/29/13)
Brownback says he's listening to Medicaid expansion proponents, opponents (4/5/13)
Oregon shows costs of putting Medicaid enrollees in private coverage (3/29/13)
Governor urged to expand Medicaid eligibility (3/27/13)
Arkansas Medicaid expansion attracts other states' interest (3/26/13)
Senate president prefers options remain open on Medicaid expansion (3/25/13)
States urged to expand Medicaid with private insurance (3/22/13)
Senate budget amendment underscores opposition to Medicaid expansion (3/21/13)
Study: Kansas employers face millions a year in possible penalties without Medicaid expansion (3/15/13)
More than 30 Kansas groups pushing for Medicaid expansion (3/12/13)
Health insurers see big opportunities in health law’s Medicaid expansion (3/8/13)
Medicaid expansion supporters to step up lobbying efforts (3/7/13)
Budget committee hears resolution opposing Medicaid expansion (2/22/13)
Legislators focusing on Medicaid expansion cost estimates (2/19/13)
Kansas hospital group study predicts expanding Medicaid would generate 4,000 jobs (2/18/13)
Brownback officials release their cost projections for Medicaid expansion (2/8/13)
Medicaid expansion bill introduced (1/22/13)
Kansas hospitals worried about loss of dollars for charity care (1/14/13)
Brownback compiling own estimate of Medicaid expansion cost (12/20/12)
Group urges Brownback to expand Medicaid eligibility (11/9/12)
Debate begins on possible Kansas Medicaid expansion (10/25/12)
Amerigroup CEO says states ‘need’ to go along with Medicaid expansion (7/11/12)
Kansas hospitals ready to get on with federal health reform, spokesman says (7/2/12)
Kansas AG claims partial victory in health reform case (6/29/12)
High court upholds Affordable Care Act, but ruling puts limits on Medicaid expansion (6/28/12)

→ Kansas Hospital Association: An opportunity for the Kansas Medicaid program
→ Americans for Prosperity-Kansas: Well-intentioned policies do more harm than good
→ Health Reform Resource Project: The cost of not expanding Medicaid
→ Rep. Jim Ward: Medicaid expansion essential for healthier Kansas
→ Rep. David Crum: Reasons for opposing Medicaid expansion
→ National Academy for State Health Policy: Much ado about Arkansas: Medicaid in the insurance exchange

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