Oscar Wilde wrote that a cynic is one who knows the cost of everything and the value of nothing. If that’s true, Kansas lawmakers just completed a very cynical legislative session.
The Affordable Care Act (ACA) provides two routes to expanded health insurance coverage. First, through new insurance marketplaces and tax subsidies, millions of currently uninsured Americans will be able to purchase health insurance. Over the next few years, more than 100,000 Kansans, nearly a third of the state’s uninsured population, will receive private health insurance under the ACA.
The second path to coverage is through the Medicaid program, which will expand to cover everyone with income below 138 percent of the federal poverty level, about $15,800 for an individual and $27,000 for a family of three. Right now, Kansas has some of the lowest Medicaid eligibility thresholds in the nation. For example, a single mother with two children is considered too well-off for Medicaid if she earns more than about $6,200 per year.
Last summer, the Supreme Court ruled that the ACA’s Medicaid expansion was optional. Each state must now decide whether to accept federal dollars to make Medicaid more widely available. During the recent legislative session, Gov. Sam Brownback and Kansas lawmakers chose not to decide. So, there will be no Medicaid expansion in Kansas.
As a result, more than 140,000 Kansans who would have been covered by Medicaid will remain uninsured. They will go without insurance despite the fact that nearly all of their health care costs would have been paid by the federal government.
The ACA offers states far more generous cost sharing than is currently available in Medicaid. Kansas paid for 43 percent of state Medicaid costs last year, a total of $1.1 billion. Under the ACA, Kansas will pay nothing for the first three years and no more than 10 percent thereafter, amounting to a total increase of $625 million in the state Medicaid budget over the next 10 years.
The Kansas legislature spent a lot of time talking about this $625 million and concluded it was unaffordable. They didn’t spend any time, however, talking about other budget items that might be reduced if Medicaid were expanded.
Savings in grants to health care providers for serving the uninsured? Not discussed.
Reduction in jail and prison costs for incarcerating fewer mentally ill Kansans? Never brought up.
Decreases in local property taxes now used to support hospital care for the uninsured? Not mentioned.
Research showing that the state would actually save more than $80 million through 2020 by expanding Medicaid? Silence.
They didn’t bother talking about other effects of Medicaid expansion, either. Better health? Improved hospital finances? New health care jobs? Not a word.
So, Kansas will continue to have one of the stingiest Medicaid programs in the nation. More than 140,000 Kansans who would have been covered will remain uninsured. Federal tax dollars paid by Kansans will go to New York, California, and other states to cover their residents under Medicaid. And the Kansas legislature still won’t know the value of what it gave up.