Gov. Sam Brownback remains sidelined on whether to extend Medicaid coverage to thousands of lower-income Kansans at little cost to state taxpayers. The governor has delayed and ducked this major issue confronting state policymakers in Kansas and every other state in the nation.
In confirming the constitutionality of the Affordable Care Act, popularly known as Obamacare, the U.S. Supreme Court ruled nine months ago that state governments could not be coerced into expanding Medicaid but must be allowed to make that choice on a state-by-state basis.
Since the court decision, most governors across the nation have weighed in on the issue, either pro or con. At least seven independent reports have analyzed Medicaid expansion in Kansas, focusing most attention on the number of low-income Kansans who would receive coverage and the financial impact on state taxpayers.
While projections of enrollment vary, the best estimate of the nonpartisan Kansas Health Institute is that 110,000 adults and 88,000 children would take advantage of broader eligibility through Medicaid expansion. ACA covers the full cost of newly eligible adults under Medicaid expansion for the first three years, 2014-16, phasing down to 90 percent in 2020 and beyond. Providing health care for these low-income Kansans over the next seven years would cost $4 for every $100 in coverage.
A report prepared for the Kansas Hospital Association projects that by 2020, Medicaid expansion would create more than 4,000 new jobs and add more than $300 million in personal income annually to the Kansas economy. Further, the report estimates that these economic impacts coupled with related health care savings would actually produce a net gain in the state budget for the period.
So, what has immobilized Brownback into a state of indecision uncharacteristic of his aggressive instincts in tackling most state issues?
On the one hand, his most intimate anti-government allies – Americans for Prosperity, the Kansas Chamber of Commerce, the American Legislative Exchange Council and their legislative collaborators – despise Obamacare as overreach into individual liberty, loathe the safety net represented by Medicaid, and vehemently oppose its expansion in any form. They applaud Gov. Rick Perry, who has dug in his heels against Medicaid expansion in Texas, a state that ranks at or near the bottom among the 50 states on most measures of health insurance coverage for children and adults.
On the other hand, a vocal array of health care advocates in Kansas support expansion of Medicaid. They point to the decision as an economic issue of creating jobs but also frame it as a moral issue, that of assisting vulnerable Kansans. They point to red-state Gov. John Kasich of Ohio, who in supporting expansion called on Ohioans to seek guidance from the Bible, stating: “I can’t look at the disabled, I can’t look at the poor, I can’t look at the mentally ill, I can’t look at the addicted and think we ought to ignore them…. For those that live in the shadows of life, those who are the least among us, I will not accept the fact that the most vulnerable in our state should be ignored. We can help them.”
Brownback has been hoisted on the horns of a political dilemma, much of his own making. His tax policies favor the rich and shift the state tax burden onto lower-income Kansans. His social-welfare policies have eliminated assistance for thousands of the neediest Kansans and threaten to unravel the safety net for thousands of other vulnerable Kansans.
Choosing to align himself with his libertarian fringe on Medicaid expansion would reinforce once again his alliance with the rich against the poor and drive his low approval ratings, now standing in the mid-30s, even further downward.