The decision by state officials not to expand Medicaid eligibility could deny thousands of uninsured Kansans access to life-saving cancer treatments, according to a recent report by researchers at the University of Kansas Medical Center.
“There are some people who will die of cancer because we’re not able to screen them or provide them with the prevention services they need,” said Dr. Edward Ellerbeck, director of the Cancer Control and Population Health Program at the medical center.
The report, issued in March, estimates that without Medicaid expansion about 40,000 uninsured Kansans may not get necessary screenings for colorectal, breast and cervical cancers or get the medical help they need to quit smoking.
“The potential for improved health and reduced financial impact of cancer would be drastically altered if Kansans with incomes less than 100 percent of FPL (federal poverty level) had access to common life-saving screening and prevention services,” the report concluded.
Currently, most of the approximately 400,000 Kansans enrolled in Medicaid – called KanCare – are poor children, new mothers, the disabled and seniors who need help paying for nursing home care. Able-bodied adults with children are eligible only if they earn less than 33 percent of FPL, or $7,770 annually for a family of four. Adults without children are not eligible. Under expansion, all adults earning up to 138 percent of poverty – $32,500 for a family of four – would be eligible.
About 40,000 could benefit
The KU report projected that Medicaid expansion would give more than 11,800 Kansans access to smoking prevention services and help more than 4,300 obtain colorectal cancer screenings. In addition, more than 20,000 women who otherwise might not receive screenings for breast and cervical cancer would have access to them if covered by Medicaid.
The projections were based on the number of Kansans expected to fall into the “gap” between 33 percent of FPL and 100 percent of FPL and the numbers within that population whose age or health status would make them eligible for the screenings.
The researchers didn’t include Kansans who earned between 100 percent of FPL and 138 percent of FPL because in addition to Medicaid they would be eligible to receive federal subsidies to help them purchase private insurance.
Tom Bell, president and chief executive of the Kansas Hospital Association, featured the KU report in a recent column he wrote for the association’s newsletter.
“This excellent study is concrete information that providing access to health care to this group of low-income, uninsured Kansans through our KanCare program could improve the health and quality of life of a significant number of our fellow citizens,” Bell wrote.
Kansas hospitals are leading the lobbying effort for expansion because administrators see it as a way to reduce the amount of charity care they provide and to offset reductions in Medicare reimbursements that they agreed to absorb to help pay for the reform law.
The Affordable Care Act called for Medicaid expansion, but the U.S. Supreme Court made it optional for states in a June 2012 ruling. Kansas is one of 19 states – most of them headed by Republican governors opposed to the ACA – that have opted not to expand the program.
Brownback: Mixed messages
Gov. Sam Brownback and Republican legislative leaders have given various reasons for opposing expansion. Initially, they questioned the reliability of the federal government’s promise to pay 100 percent of expansion costs for the first three years and not less than 90 percent thereafter.
More recently, the governor has said he doesn’t want to increase Medicaid enrollment until the state can afford to serve Kansans with physical and developmental disabilities who are now on waiting lists.
However, just before the start of the Medicaid expansion debate, Brownback stressed the importance of early detection in an open letter to “the citizens of Kansas” published as part of the state’s 2012–2016 cancer control plan.
“It is imperative for Kansans to work with their physicians to determine what screenings are appropriate for them based on family history and risk factors,” Brownback wrote. “It is important to understand that being diagnosed with cancer means it is time to fight. Working together, we will beat this disease.”
Limited help available
Since the mid-1990s, more than 20,000 Kansas women have received screenings and treatment for breast and cervical cancer through the Early Detection Works program. The $2.7 million program, funded mostly with federal Medicaid dollars, covers regular cancer screenings for Kansas women ages 50 through 64 and confirmatory tests for women ages 40 through 49 who have cancer symptoms. A limited amount of state money and foundation dollars are available to help women under 40 obtain screenings and treatment.
“We’re screening about 21 percent of the eligible population right now,” said Paula Clayton, director of the Bureau of Health Promotion at the Kansas Department of Health and Environment. “Over the years, that has continued to grow.”
The Early Detection Works program is important, Ellerbeck said, but it falls far short of addressing the need among low-income women because they must see a provider to enroll.Only women who earn less than 225 percent of FPL – about $50,000 a year for a family of four – can qualify for the program.
“How are they going to get in to see a provider to get into the Early Detection Works program if they don’t have any insurance?” he asked. “It certainly isn’t reaching all of the women in need of breast and cervical cancer screening.”
Clayton acknowledges that the Early Detection Works program is only part of the solution. But, she said, it has so far had sufficient resources to serve all eligible women who applied.
“It’s not that we’re turning women away,” she said. “We don’t have a waiting list.”
Even so, Ellerbeck said, the program is no more than a “Band-Aid” in the state’s fight to prevent deaths from treatable cancers.
“It is certainly not taking care of colorectal cancer and it’s certainly not taking care of all of the people who smoke,” he said.
Colorectal cancer is particularly troubling for Ellerbeck, who volunteers once a week at the Swope Health Services safety net clinic in Wyandotte County. Even though 60 percent of colorectal cancer deaths could be prevented by early detection, Ellerbeck said it’s virtually impossible to get colonoscopies for his clinic patients.
“For the most part, we don’t even offer screening tests because we don’t have anything to do with the results,” he said. “We can’t do what’s best for them. It’s very frustrating.”
Jim McLean is the executive editor of KHI News Service, an editorially independent reporting program of the Kansas Health Institute.