In a followup to Gov. Kelly’s opinion editorial on Sunday regarding Medicaid expansion in Kansas, I am sharing my experience as a member of her council on expansion.
We are a bipartisan group with a variety of expertise and experience. To recap, Kansas is one of only 14 states left that has not expanded its Medicaid program to provide access to comprehensive, integrated care for low-income adults.
While being late is never ideal, being in this position means we have the opportunity to study other states’ implementation and take the best elements from each. We are studying data collected from the 34 states that have already expanded Medicaid. We are looking at what worked — and what didn’t. By the end of the year, we plan to put forward some guiding principles for Kansans to consider when expanding Medicaid.
The council’s process has been exemplary. The discussion is moderated by the National Governors Association, a nonpartisan, 100-year-old organization of the nation’s 55 governors. We began by learning the history of the Medicaid program, what Medicaid benefits look like across the country and in Kansas today, and hearing from health policy advisors from Montana and Ohio, who shared the first-hand experiences of their states’ expansion.
We also heard from Adam Proffitt, Kansas Medicaid Director, who is in the ideal position to share his knowledge about the most efficient way to implement expansion in Kansas.
KanCare (Medicaid in Kansas) expansion is expected to generate more than 13,000 new jobs and bring nearly $700 million of new funding into our state each year. Research indicates that Medicaid expansion is linked to gains in health coverage, improvements in health access, improved financial security, improvement in health status and outcomes, and provides economic benefits for states and providers.
Other interesting things I learned:
• Straight Medicaid expansion would provide health coverage for all Kansans who earn up to 138% of the federal poverty level. So, for a family of four to be eligible for coverage under expansion, their annual gross income would have to be $34,638 or less.
• Straight expansion is the most efficient use of funding and would cost Kansas the least amount to administer. In states that have gotten waivers to collect premiums, co-pays and impose work requirements their administrative costs have been significantly higher than they would have been by just expanding coverage. Additionally, any money collected in fees has to be split with the federal government 90/10 so for every dollar collected we would be left with just 10 cents.
• Nebraska has adopted expansion, Missouri and Oklahoma will have expansion as initiatives on their ballots in the 2020 election. This could mean that all of our surrounding neighbors will have expanded Medicaid.
• Montana has not had a single rural hospital or clinic close since expanding Medicaid while hospitals in nonexpansion states are six times more likely to close.
States that have expanded Medicaid have seen net savings in their state budgets due to a combination of many factors including:
• Decreased demand for targeted Medicaid programs that serve low-income people with specific health conditions but are funded at the state’s regular, lower matching rate.
• Decreased demand for health programs that are entirely state-funded such as mental and behavioral health programs.
• Increased revenue from existing taxes on health plans and providers.
All the data suggests that the most fiscally conservative, cost efficient, effective way to expand Medicaid is to do straight expansion without applying for waivers from the federal government.
Ximena M. Garcia is a retired physician who lives in Topeka.