At the same time, the proportion of nonelderly adult Kansans covered by publicly funded insurance has increased, from 5.5 percent in 2000–2001 to 7.8 percent in 2008–2009. A similar increase was seen for the United States as a whole. Similar trends were seen for children covered by employment-based and publicly funded insurance during this time period. These trends are likely to accelerate even more under the Medicaid expansions included in the ACA.
There is an active debate about which came fi rst: the decrease in employment-based insurance coverage or the expansion of publicly funded insurance. Certainly there is some “crowd out” of private insurance, including coverage through an employer, when publicly funded insurance is made available. Nonetheless, it is likely that the uninsured rate in Kansas and the United States would have increased even more sharply in the face of decreasing employment-based insurance over the last decade if publicly funded insurance had not expanded.
Insurance Coverage Likely to Change Under ACA
In 2014, the ACA expands Medicaid eligibility to cover all legal residents with annual family incomes at or below 133 percent of FPL, or $29,726 for a family of four. In Kansas, this expansion primarily will affect non-disabled adults, who currently are eligible only if they have children and their annual family income is below 27 percent of FPL ($6,035 for a family of four). Non-disabled adults without children are not currently eligible for Medicaid in Kansas regardless of income. The Medicaid eligibility expansion slated for 2014 will significantly increase the number of Kansans covered by Medicaid. Enrollment is projected to grow by as many as 130,000 Kansans from the more than 300,000 currently covered.
One of the most controversial aspects of the ACA is the requirement that essentially all Americans obtain insurance coverage or face the possibility of financial penalties. Kansas and 25 other states are participating in a federal lawsuit challenging the constitutionality of this individual mandate, and a Supreme Court ruling is expected in 2012.
Along with the mandate to get insurance, the ACA contains provisions designed to help make health insurance more affordable for some Kansans with incomes too high to be eligible for Medicaid. For example, the ACA provides tax credits and cost-sharing subsidies to individuals in families earning less than 400 percent of FPL who purchase coverage through an insurance exchange. Nearly 90 percent of uninsured Kansans fall between 133 percent and 400 percent of FPL and could bene.t from these subsidies. Small businesses may be eligible for tax credits to help them with the cost of insurance obtained through an insurance exchange for their employees.
Considering the uncertainty surrounding political and legal challenges to the ACA, changes in the Kansas Medicaid program proposed by the Brownback administration and projections for the federal deficit and state revenues, it is clear that insurance coverage and health care in Kansas will change significantly in the years ahead. Tracking and understanding where Kansans get their health insurance and how that coverage is funded are important issues for state policymakers charged with keeping Kansas economically competitive and fiscally sound.