No excuse on Medicaid expansion
If the uncertain legal future of the Affordable Care Act seemed reason enough to keep stalling on Medicaid expansion in Kansas during the legislative session, that excuse is gone.
The tax credit subsidies in states that use the federally run online exchange prevailed in last week’s 6-3 decision at the U.S. Supreme Court, leaving intact the ACA coverage of nearly 70,000 Kansans among millions of Americans.
With that chaos averted, state leaders are free to judge the proposed expansion of Medicaid on its own merits, which are compelling. Under the ACA, the federal government will pay nearly the entire cost for states to expand eligibility up to 138 percent of the poverty level – individuals with incomes up to $16,105 a year and up to $32,913 for a family of four. About 131,000 uninsured Kansans could be newly covered by KanCare, the state’s privatized, managed-care version of Medicaid.
Yet some are now acting as if the court decision lets them off the hook.
“The relief valve was triggered by the court’s ruling, as unique as it was,” said Senate Majority Leader Terry Bruce, R-Hutchinson – ignoring how expansion could help those who earn too much to qualify for Medicaid yet too little to afford their own ACA plans even with subsidies.
“Right now, there’s not a whole lot of support,” said House Health and Human Services Committee Chairman Dan Hawkins, R-Wichita – as if forgetting how proponents packed the room during the two days of emotional hearings before his panel in March.
On Tuesday the Kansas Republican Party even counted defeating Medicaid expansion among the accomplishments of the legislative session. Gov. Sam Brownback remains the biggest holdout, of course, telling the Associated Press through a spokeswoman that he first wants to address the waiting lists for in-home care for the disabled (a fine goal, but one unrelated to Medicaid expansion) and has doubts about the financial sustainability of expansion.
A Kansas Hospital Association study concluded that expansion will pay for itself. And what about the financial sustainability of hospitals in the state if Medicaid is not expanded? Many are facing brutal cuts in federal reimbursements for uncompensated care – reductions always intended to be offset by federal support for states’ Medicaid expansion under the ACA. Kansas’ leaders have been warned over and over that their inaction could cripple hospitals, including many in underserved rural areas.
But rather than join the 29 states that have expanded Medicaid, Kansas’ leaders would rather fight the Obama administration: Last week Attorney General Derek Schmidt and nine red-state counterparts asked Congress to investigate whether the administration is trying to coerce states to expand Medicaid by withholding money.
The governor and other state leaders fail to understand that they aren’t merely sticking with the status quo by refusing to expand Medicaid. They are neglecting a crisis in the making.
For the editorial board, Rhonda Holman
This story was originally published July 2, 2015 at 7:07 PM.