Originally published by Kansas Reflector on March 7, 2021:
TOPEKA — New estimates of how many Kansans could gain coverage through Medicaid expansion are down from previous years, but researchers for the Kansas Health Institute say this is not surprising given the uncertainty of income throughout the year.
The 2021 estimates by KHI indicate 126,000 Kansans, including nearly 88,000 adults, would newly enroll in KanCare, the state’s privatized version of Medicaid, if the program were expanded. Estimates use data compiled before COVID-19 and assume implementation on Jan. 1, 2022.
The new figure is a drop-off from the 2020 estimate of 132,000 new enrollees, but Phillip Steiner, an analyst with KHI, said both federal policymaking and the program review process could be accounting for the lower number. More Kansans may be lacking coverage at certain times than others, he said.
“In Medicaid, there are a lot of folks who their income is very uncertain throughout the year. It could maybe go up and down as they pick up more hours at work,” Steiner said. “There’s a cycle of annual reviews, and they will get removed from the program at certain points, and then they’ll maybe reapply and come back on.”
“One of the main policies that federally was enacted around COVID was keeping folks enrolled in Medicaid,” he added. “So, there’s a lot of these people who are right on the bubble, currently are staying enrolled and would likely be a population that would be covered under the Medicaid expansion.”
Several attempts have been made to expand Medicaid in Kansas, and all have failed. Amid COVID-19, the outcry to expand the health care program has intensified, but Republican legislative leadership remains opposed. Efforts this session have been refused thus far.
In 2020, Missouri and Oklahoma joined Nebraska and Colorado in expanding Medicaid, surrounding Kansas with states that have already expanded or will soon expand to low-income adults under the terms of the Affordable Care Act. In exchange for expanding eligibility, the ACA reimburses states for 90% of all Medicaid expenses.
While the new KHI figures represent an approximately 31% increase in KanCare enrollment, they estimate the total spending to only increase by 2.7% on a per year average over 10 years. Total costs over those 10 years would be just more than $600 million for new adults, current adults and current children.
Not included in the cost-benefit analysis are indirect effects of expansion on the economy and jobs, something Democratic proponents have touted as a critical component to the need for such action.
“I have repeated time and time again that Medicaid expansion is a no-brainer,” said Gov. Laura Kelly. “In addition to expanding coverage, it injects billions of dollars into our local economies. It creates jobs, and it protects our hospitals.”
In early 2020, Kelly announced bipartisan expansion legislation co-sponsored by 22 members of the 40-person Senate. However, the legislation stalled when then-Senate President Susan Wagle declared it would not be brought to the floor unless an anti-abortion constitutional amendment was passed.
Kelly reinitiated her efforts in the 2021 legislative session in early February, announcing a proposal to fund the expansion of Medicaid through revenue from the legalization of medical marijuana.
The legislation to carry out that vision was introduced last week to the House Committee on Federal and State Affairs by Rep. Brandon Woodard, D-Lenexa. Woodard said the bill would be revenue neutral. He also stressed the need to trigger the 90% match for whatever the state puts into the program.
The balanced cost and federal funds should make it more appealing to skeptics, Woodard said.
“We’ve really got to appeal to the senses of these folks who want to build a healthy economy as we move forward,” he said. “We hear all the time in this building about mental health, about good jobs and a strong economy or opening the economy. We can’t do that without a healthy workforce, and expansion is one of the most essential parts of rebuilding that economy.”
Woodard said obtaining the necessary number of legislators to back the bill is a steep uphill battle but that he will remain vigilant in his efforts to do so. Even if the measure should pass the House, it faces a more daunting challenge in the Senate, where legislators have already rejected one expansion proposition.
On the Senate floor Wednesday, Republican lawmakers quickly brushed aside an amendment from Minority Leader Dinah Sykes, D-Lenexa, to a mental health bill that would have expanded Medicaid in Kansas.
“It is critically important to preserve Medicaid for the vulnerable Kansans for whom it was intended, such as the elderly, the disabled and other vulnerable communities,” said Senate President Ty Masterson, R-Andover. “The best way to improve access to health care is to create more choices for Kansans by removing barriers to competition and removing the regulations that drive up that drive up the cost of health care.”
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