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Debate begins on possible Kansas Medicaid expansion

Battle lines are forming over the question of opening up the program to more people

By Mike Shields, Dave Ranney | October 25, 2012

A Kansas health consumer group is planning a post-election rally at the Statehouse in support of expanding the state’s Medicaid program.

Meanwhile, Lt. Gov. Jeff Colyer today headlined an event in Overland Park that was sponsored by a conservative think tank that opposes broadening the Medicaid program. Colyer, however, didn't make explicit what intentions, if any, the administration of Gov. Sam Brownback might have with respect to the issue.

Anna Lambertson, executive director of the Kansas Health Consumer Coalition, said the group "wants to get the dialogue started," on the potential benefits for Kansans, if policymakers here decide they will open up eligibility to include adults earning up to 133 percent of federal poverty guidelines.

Currently, the state's Medicaid program is mostly restricted to poor children, pregnant women, the disabled and the elderly. A non-disabled adult rearing children is currently eligible for Medicaid, if his or her income is below 32 percent of the poverty level – about $5,200 a year for a young mother with two children.

Kansas’ eligibility threshold is among the lowest in the nation.

Affordable Care Act

Under the federal Affordable Care Act, commonly referred to as Obamacare, states would have the option of expanding their Medicaid programs to include adults with incomes at or below 133 percent of federal poverty guidelines or about $30,700 a year for a parent in a four-person household or about $14,900 a year for a childless adult.

Brownback, an outspoken critic of the health reform law, has said he won't consider any aspect of the health reform law's implementation, including a possible Medicaid expansion, until after the Nov. 6 election.

Republican presidential candidate Mitt Romney has pledged to repeal the law, if elected.

Governors in at least six states – Florida, Georgia, Louisiana, Mississippi, South Carolina, and Texas – have said they will reject the expansion, citing concerns that it would prove to be too expensive and would expand – rather than shrink – the role of government.

Governors in at least 13 states have said they will expand the program.

According to a preliminary estimate by analysts at the Kansas Health Institute, if the expansion is approved here it could add 130,000 people to Kansas Medicaid by 2019.

Colyer was the main speaker at a Kansas Policy Institute (KPI) meeting today in Overland Park that drew about 60 people, including several Republican state legislators. He confined his remarks to describing the administration's rationale and goals for its KanCare Medicaid reforms.

He didn't offer new information, but instead repeated points he and other administration officials have made in various venues since unveiling their plan about a year ago. He didn't touch on the question of Medicaid expansion and did not take queries from the audience before leaving for another engagement.<a name="continued"></a>

Kansas Policy Institute President Dave Trabert.

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'Crowd out'

But earlier in the two-hour event, KPI President Dave Trabert said that expanding Medicaid in the state could increase the program's enrollment by 254,000 people by 2023 and increase state general fund spending on Medicaid by $4.7 billion within a decade.

He said if state officials chose to expand Medicaid eligibility, the increased costs would "crowd out" state spending on other programs such as education and public safety.

Colyer praised the policy institute for its work and support of administration policies.

But Lambertson said thousands of Kansans could gain health coverage, if policymakers choose to expand the Medicaid program.

“There are a lot of parents out there whose employers don’t provide health insurance,” she said. “They may be able to scrape together some kind of coverage for their kids, but they can’t afford insurance for themselves.”

Federal match

Under the law, the federal government, starting Jan. 1, 2014, would finance 100 percent of the costs of covering the newly eligible Medicaid enrollees for three years: 2014, 2015 and 2016.

The federal match would drop to 95 percent in 2017; 94 percent in 2018; 93 percent in 2019; and 90 percent in 2020 and beyond.

Currently, the federal government picks up about 57 percent of the state’s Medicaid cost. The state pays the remainder.

The program’s total cost next year is expected to reach $3.2 billion.

Lambertson said she thought the Brownback administration likely would resist expanding Medicaid.

"We’re saying there ought to be a public discussion leading up to that decision.”

The rally, Lambertson said, was meant to “kick off” that discussion. It is scheduled for noon on Nov. 9 on the south steps of the Statehouse.

"We also want to raise awareness of how extending Medicaid would make a real difference in the lives of Kansans who, right now, cannot access the coverage they need," she said. "People who lack health insurance are less likely to see a doctor and more likely to forego the medical care they need and then their conditions become much more expensive to treat. The lack of health insurance is among the top factors for filing bankruptcy in this country."

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