There has been much talk about Medicaid Expansion in recent years. Unfortunately, most of the coverage is from the perspective of expansion advocates. The truth about expansion is very different than how it has been sold to the public. 

To have a true understanding of Medicaid Expansion, a person must first know who is already covered. The frail and elderly, pregnant women up to 150 percent of Federal Poverty Level (FPL), mothers for one year after giving birth up to 150 percent of FPL, children below 250 percent of FPL, parents of children up to 38 percent FPL, those applying and waiting for disability determination, the physically disabled, the intellectually/developmentally disabled, those with traumatic brain injuries, the blind and children with autism are already covered by a form of government health care coverage. Medicaid Expansion does not help these populations. They are already covered. 

The next step in understanding Medicaid Expansion is to look at the new population it would bring into the fold of government funded healthcare. The expansion population is predominantly childless, able bodied adults between the ages of 19-64. Most of this population does not work despite the low levels of unemployment in our state. If these individuals worked 31 hours per week at a minimum wage job, they would qualify for healthcare through the federal healthcare exchange.

Further, it is estimated that more 50,000 people that already have insurance would be able to transfer to the government funded insurance; which means that taxpayers will foot the bill.   To reiterate, that is for people that already have insurance. 

It’s understandable that hospitals would favor Medicaid Expansion. Expansion would lead to taxpayer dollars being funneled into their coffers. There has been much discussion that expansion would save the rural hospitals. This is a myth. Rural hospitals would receive very little funding from expansion. Out of all the hospitals spread throughout Kansas, the 10 largest hospitals would receive over half of the expansion dollars. Nearly 25 percent of expansion dollars would go to the two largest hospitals alone. Expansion is not a cure-all for rural hospitals. 

One final point I’d like to touch on is the cost of expansion. There have been numerous numbers floating around on what expansion would cost the taxpayers. The bi-partisan Kansas Health Institute estimates that the expansion population in Kansas numbers 129,334. They estimate a first full year net cost to the state of $47.4 million and a net cost to the state of $520.8 million over 10 years. This net cost factors in estimated new revenues, costs and savings that could result from expansion. The total gross cost to the state over a 10-year period would be $1.2 billion. Even more concerning is that every state that has expanded Medicaid has seen enrollment significantly exceed estimates. Several states are currently suffering the budgetary fallout of these higher than expected costs.  The question needs to be asked: if other state’s estimates of cost have been lower than actual costs, is it likely that the same would happen in Kansas?

Improving healthcare outcomes and providing quality health care to rural citizens are worthy goals to be certain. Forcing state taxpayers to pay hundreds of millions of dollars to provide free health care to able bodied adults who have other options is a less worthy goal. Medicaid is meant to be a safety net, helping those who cannot help themselves. If there are holes in the net, we should address those issues. The answer is not flooding an already broken system with nearly 130,000 new participants. 

Steve Abrams

Arkansas City

Former state senator

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