Medicaid expansion is nowhere to be found on Gov. Sam Brownback’s list of priorities and those of Republican legislative leaders as they work through a legislative session now dominated by school finance issues.
But that didn’t stop nearly 200 expansion supporters from crowding into a wing of the Statehouse adjacent to the governor’s office on Tuesday for a noisy rally. The event was staged by more than 50 health care and social service organizations organized under the banner of the Kansas Medicaid Access Coalition.
Sean Gatewood, a former Democratic legislator from Topeka and director of the coalition, outlined the case for expansion by reminding the crowd that the state’s current Medicaid program is one of the most restrictive in the nation.
“If you don’t have kids and you don’t have a disability and you’re just a childless adult there is no Medicaid for you. It doesn’t matter if you don’t make a dime,” Gatewood said.
In Kansas, childless adults are not eligible for Medicaid no matter how poor they are. Adults with children are eligible but only if they earn less than 32 percent of poverty, about $630 a month for a three-person household.
The federal health reform law allows states to increase Medicaid eligibility for all adults with annual earnings up to 138 percent of poverty – $15,856 for individuals and $35,325 for a family of four. And the law requires the federal government to pay 100 percent of the costs for three years. After that, the federal share gradually declines until it reaches 90 percent.
Without expansion, an estimated 80,000 uninsured Kansans are expected to fall into what is being called the Medicaid gap. They are ineligible for the existing Medicaid program but are too poor to qualify for federal subsidies to help cover the cost of private coverage in the Obamacare marketplace.
Georgia Masterson traveled from Iola to attend the rally and lobby legislators from her area. A former state employee, Masterson now helps people select health coverage on the healthcare.gov website as a certified navigator. She said she’s counseled several people who made too little to qualify for federal subsidies and too much for Medicaid.
“It’s very frustrating and it’s very heartbreaking,” Masterson said.
Many of those expected to end up in the gap are seniors who lost their jobs and health insurance before they were old enough to qualify for Medicare, said Mary Tritsch of AARP Kansas.
“They’re not eligible to be on Medicare until they’re 65 so they’re caught in a gap and they really need this,”Tritsch said. “We’re estimating that a little over 20,000 Kansans are in that position.”
The rejection of Medicaid expansion is also squeezing Kansas hospitals financially. They’re being forced to absorb cuts in Medicare reimbursements that were supposed to be offset by higher Medicaid spending.
A report from the Kaiser Commission on Medicaid and the Uninsured estimated that rejecting expansion would cost Kansas $5.3 billion in federal aid between 2013 and 2022.
By Tuesday evening, a ticker on the Kansas Health Consumer website that continuously updates how much money Kansas has lost since Jan. 1 was closing in on $83 million.
None of the arguments advanced by expansion supporters have carried the day with opponents. Just last week, Brownback restated his opposition to expansion, saying it would be wrong to allow more able-bodied adults into Medicaid when thousands of people with physical and developmental disabilities are still on waiting lists for services.
“I want us (first) to take care of the people who are on the waiting lists now,” Brownback said after addressing an event organized by mental health advocates.
A Medicaid expansion bill introduced early in the session by Rep. Jim Ward, a Wichita Democrat, never received a hearing and remains bottled up in a House committee.
Senate President Susan Wagle, a Wichita Republican, has said she is open to discussing the kind of private-sector approaches to expansion being taken in other states by GOP governors. Those plans require federal approval to use Medicaid money to subsidize the purchase of private coverage.
Wagle said continued opposition to the Affordable Care Act and problems with its implementation made it impossible to discussed the related Medicaid expansion issue this session."I believe if the federal government would give us the flexibility then we could arrive at a plan that works for Kansas," Wagle said.
“We don't have a predictable environment to legislate from,” she said.
Jacki Chase is the head nurse for the Iola school district and the daughter of the late Robert Talkington, the president of the Kansas Senate from 1985-1989. She said she supports Medicaid expansion but understands why some legislators don’t want to deal with it in an election year.
“It is a politically charged issue that relates back to the Affordable Care Act and whether that is going to be successful,” Chase said. “I think they don’t want to address it and possibly have it used against them in this year’s election.”
In 2010, political organizations spending hundreds of thousands of dollars used the Obamacare issue to defeat several moderate Republican members of the Kansas Senate.
Jim McLean is a reporter with KHI News Service, an editorially independent reporting program of the Kansas Health Institute.