After a decade-long battle to implement new Medicaid guidelines in Missouri, the expansion finally passed in 2020, extending coverage to more than 200,000 newly eligible adults. Missouri is one of 39 states to date that has adopted Medicaid expansion, including Colorado, Nebraska, and Oklahoma, among others. Now surrounded by states that made the switch and seeing the positive impact it has had, many Kansans are wondering when their state will follow suit.
On February 9, Governor Laura Kelly’s new legislation to expand KanCare, Kansas’s Medicaid program, was introduced to the House floor. Under the proposed bill, Medicaid expansion would cover Kansans earning up to the full 138% of the Federal Poverty Level beginning January 1, 2023. According to Kelly, about 90% of the expansion would be paid by the federal government.
Previously, the governor cited the challenges of COVID-19 as the driving force behind the legislation, stating that recovering from the pandemic will require protecting the health of Kansas’s workforce and economy. If Medicaid is expanded, the state is expected to receive an additional $68.5 million in State General Fund savings in 2023 alone, which will be reallocated toward an investment in housing, childcare, and workforce development.
According to a recent survey conducted by Alliance for a Healthy Kansas, almost eight in 10 Kansas voters support the expansion of Medicaid in Kansas. Amid rising costs of living, including food and gas as well as health care, the majority of survey respondents (89%) cited fear of medical debt as an additional concern, especially for those already struggling with the costs of care.
Survey results also indicate that interest in KanCare spans communities, both geographically and politically. Favored among 85% of people in urban areas and 73% of rural areas, expanding KanCare is a clear choice to alleviate shared concerns on access to care. With support from 96% of Democrats and 65% of Republicans, KanCare could unite the state in making the best choice for health care consumers, the work force, and the economy.
The expansion of Medicaid in Kansas could grant coverage to more than 165,000 adults, allowing more Kansans the access they need to remain healthy, especially amid a global pandemic. It would also return adults to the workforce and keep them working longer as they are able to invest in and better manage their health. With other states reporting that Medicaid expansion boosted not only the workforce but the economy, the decision is clear – there is no reason to further put off expanding Medicaid coverage in Kansas.
Investing in a Healthy Workforce
During a recent virtual discussion titled “Medicaid Expansion in Kansas,” panelists Lieutenant Governor David Toland and Kansas State Senator John Doll discussed the economic and community health impact the expansion would have. Throughout the discussion, the two focused on the positive impact KanCare would have, citing evidence that supports the bill Kelly is currently attempting to pass.
According to Toland, who is also the Kansas Secretary of Commerce, there are simply not enough healthy and able people on the workforce bench to man the amount of work available. With 64,000 currently open jobs, and an unemployment rate of 6.3%, he believes it’s clear that the focus needs to be on investing in the wellbeing of working adults.
“Health and economic opportunity go hand in hand,” Toland said. “If you don’t have basic health care and quality of life care, our efforts at the state level to grow the state’s economy won’t work. You cannot have a robust economy without a strong workforce.” To strengthen the workforce, he believes working adults need to prioritize preventive care – a feat made much more affordable and accessible with the expansion of Medicaid through KanCare.
Healthy workers are better workers. A lack of insurance leaves many avoiding care until an emergency arises, causing them to work while ill, miss work to receive urgent care, or leave the workforce entirely to manage long-term or chronic health conditions. Access to affordable insurance is especially crucial in rural areas, where agricultural employers may not be able to formally offer insurance and employees are quickly replaced if they are ill or injured for more than a few days.
By investing in the expansion of affordable insurance through KanCare, businesses can encourage employees to prioritize preventive care, allowing them to remain healthy and working. At a time when employers are stretched to fill shifts due to the COVID-19 pandemic and ongoing Great Resignation, it’s more important than ever for businesses to have a full, healthy, and reliable staff.
For businesses looking to expand into or recruit workers from neighboring states, both Toland and Doll agree that it will not be easy. Because Kansas is surrounded by states that have expanded Medicaid, workers will likely be hesitant to leave. “People want health care, that’s an essential of life,” Doll said, pointing out that there is little incentive for workers to move for work and lose their access to care in the process.
A Sustainable Solution
Lack of access to insurance, especially affordable insurance, creates a domino-effect of negative outcomes that affect not only working adults, but their communities as well. When uninsured workers treat health concerns last minute and solely in emergency rooms, they are not only risking personal health complications. Emergency room visits are unfunded, leaving it up to hospitals to make up the difference.
According to Doll, there will be an estimated cost of about $60 million if Medicaid is not expanded. “It’s now costing the state general fund money because we continue to turn this down,” he said. To help underscore this growing and devastating cost, Alliance for a Health Kansas displays a real-time estimate of state dollars lost while waiting for expansion.
To replace funds and remain open, hospitals are forced to take a large hit on property tax. This especially hurts smaller rural hospitals, many of which consistently fight to keep their doors open. When hospitals close, communities lose access to care as well as any specialty services offered. Jobs are lost as well, further impacting the economy, and most importantly, patients are put out. The Where it Hurts podcast documents the closure of one rural Kansas hospital and the rippling impact on surrounding communities. Patients already traveling far distances to receive life-saving care were suddenly left alone to fend for themselves.
Continuing to allow uninsured workers to rely solely on ERs for health care is simply not a sustainable solution. Throughout the virtual discussion, Doll and Toland frequently mentioned the working people falling through the gaps, highlighting how senseless the current state of care is in Kansas. Erica Andrade, the discussion’s moderator and host from El Centro, shared a personal anecdote about who exactly is being left behind.
During her time as an application counselor, assisting adults applying for health insurance, Andrade met a working mother who was also attending nursing school. While attempting to apply, the two discovered that the mother made too much money to qualify for Medicaid, but not enough money to qualify for other forms of insurance, including employer-offered plans.
Despite being an active member of the workforce, a student working towards a nursing profession, and a mother caring for children, the woman was denied coverage simply due to senseless boundaries. “There are people who don’t make enough money to qualify for health,” Toland said. “That sounds like it doesn’t make sense and that’s right – it doesn’t make any sense.”
According to Alliance for a Healthy Kansas, under the current Medicaid guidelines, an uninsured parent in a family of three earning more than $4 an hour, as well as single childless adults, are not eligible for coverage at all. Under the expanded guidelines for KanCare, both single adults and parents earning more than $4 an hour ($8,345 annually) would qualify.
Evidence of Success
As the discussion brought to light, the argument against expanding Medicaid is unbased. This is no longer an experiment; 39 other states have already made the move, reported positive impacts on community health and the economy, and have continued to uphold the decision. There is no doubt: Medicaid expansion saves dollars and lives.
Research shows that despite the spending in expansion states, many also saw hundreds of millions in savings due to offsetting costs of other avenues of care, such as relying on ERs. Evidence also finds that states with expanded Medicaid experienced a drop in morality of the target population. Choosing not to expand Medicaid results in excess and preventable deaths, as well as costs to the state.
To drive home the importance of expanding Medicaid in Kansas, Doll and Toland suggest sharing personal anecdotes speaking to the positive impact it will have on those who have been left behind in health care. “What really connects with people is stories,” Toland said. “We’re going to keep fighting until we get this done but it’s going to take all of us reinvesting in this fight to get this done after all these years of trying and trying. We will get there eventually, and it will be by all of us holding hands and working together.”