KHI News Service

Safety-net officials urge Kansas Medicaid expansion

Insurance commissioner says decision not to "just makes no sense"

By Dave Ranney | September 27, 2013


LAWRENCE — State lawmakers' resistance to expanding Medicaid “just makes no sense,” Kansas Insurance Commissioner Sandy Praeger said Thursday, speaking at a meeting of safety-net clinic officials.

Many legislators, she said, “really don't understand” the consequences of not expanding Medicaid because there was “almost no discussion of the Affordable Care Act” during this year's legislative session.

Praeger, who has been hosting a series of informational forums on the health reform law for the past three weeks, said legislators will have a hard time not addressing Medicaid expansion in 2014.

“People are starting to understand what the lack of Medicaid expansion means,” she said. “And I think legislators are starting to hear from them.”

Currently in Kansas, non-disabled adults with children are eligible for Medicaid if their incomes fall below 32 percent of the federal poverty level, roughly $6,250 a year for a family of three.

“Let me put that in perspective for you,” said Health Reform Resource Project Director Sheldon Weisgrau, who also spoke at the annual conference of the Kansas Association for the Medically Underserved. “That means that a mother with two kids who works a minimum-wage job half-time makes too much money to be on Medicaid,” though the children would qualify.

Childless, non-disabled adults, are not eligible for Medicaid “under any circumstances,” he said.

Under the Affordable Care Act, commonly known as Obamacare, the federal government will cover all or most of the costs of expanding Medicaid to include adults whose incomes fall below 138 percent of the poverty level. However, expansion is optional and up to the political leaders in each state.

Low-income children and pregnant women already are covered under Medicaid.

In Kansas, Medicaid expansion would insure about 130,000 adults who are currently uninsured, according to various estimates.<a name="continued"></a>

Gov. Sam Brownback and the Republican majorities in both the House and Senate have shelved the Medicaid-expansion debate, saying they doubt the federal government will be able to keep its promise to cover most of the costs.

Cost of expansion

If adopted, Medicaid expansion would cost the state about $625 million over 10 years, according to a projection by the Brownback administration.

“To put that number into context, last year the State of Kansas spent $1.2 billion in state money on Medicaid,” Weisgrau said. “This increase of $625 million is over 10 years, but the Legislature decided we could not afford that.”

The administration's calculation, he said, did not include the offsetting costs to local programs — county health departments, safety-net clinics, hospitals — for covering the needs of the uninsured.

“Another thing that the Legislature did not discuss is how much money we spend incarcerating mentally ill, uninsured people,” Weisgrau said. "Jails and prisons are the biggest mental health system we have in the United States. Kansas is no exception to that. Yet (legislators) did not consider how many mentally ill, uninsured people might be covered by Medicaid expansion and, therefore, perhaps stay out of jail.”

By not expanding the program, Weisgrau said, lawmakers are denying the state's safety-net clinics more than $12.6 million in funding in 2014.

Jason Wesco, chief executive of the Health Partnership Clinic in Johnson County.

View larger photo

They also have created a “donut hole” in which adults earning more than 32 percent but less than 100 percent of the poverty level will be “too rich” for Medicaid and “too poor” for the tax credits and subsides in the Affordable Care Act.

Several safety-net clinic directors said that would be disastrous for their operations.

“Two-thirds of the people we see will be in the donut hole,” said Jason Wesco, chief executive at Health Partnership Clinic in Johnson County. “For us, Medicaid expansion would bring in an additional $1.5 million."

He said the clinic's current annual budget is $3.5 million.

“There is so much that we could be doing with that money,” Wesco said. “In Johnson County, there are 103,000 people who don't have insurance. We see about 8,000 of them. We're just barely scratching the surface.”

Photo by Sean Steffen, Pittsburg Morning Sun.

Krista Postai — right, chief executive of the Community Health Clinic of Southeast Kansas — talks with University of Kansas Chancellor Bernadette Gray-Little in 2009.

View larger photo

Krista Postai, who runs the Community Health Centers of Southeast Kansas in Pittsburg, said that in Southeast Kansas more people could benefit from Medicaid expansion than will from the subsides and tax credits in the Affordable Care Act.

“I really, truly believe that if we're ever going to get to the point where we're really going to move the needle on our health-care outcomes, we're going to have to have Medicaid expansion,” Postai said. “If we're going to take the next step, there's going to have to be a funding stream that isn't there now. Medicaid expansion would make that happen.”

Dr. Rachel Eash-Scott, medical director at the Health Ministries Clinic in Newton, said she “routinely” encouraged her patients — 60 percent of whom are uninsured — to share their health-care concerns with the Governor's Office.

“These are people who don't want a handout,” she said. “These are people who want to get better.”

CORRECTION: An earlier version of this story incorrectly stated the income range of Kansans who will not qualify for Medicaid or federal tax credits in the health insurance marketplace.

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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