A proposal to expand Medicaid could have a difficult time regaining momentum after a state official testified that it would cost Kansas more than $2 billion over 10 years.
The House Committee on Health and Human Services did not advance the bill on Thursday, leaving it in limbo.
Susan Mosier, acting secretary for the Kansas Department of Health and Environment, gave testimony that was officially neutral on the issue. But some lawmakers said her comments made many of the same points as testimony from the bill’s opponents.
HB 2319 would raise Medicaid eligibility to 138 percent of the poverty line, or less than $33,000 in annual income for a family of four. Under the Affordable Care Act, the federal government would pay 100 percent of the costs in 2016, but reduce its contribution to 90 percent by 2020, leaving the remainder to the state.
Mosier testified that expanding Medicaid to cover more than 150,000 uninsured Kansans would cost the state an additional $2.4 billion from 2016 through 2025. But some lawmakers said her numbers were inflated.
The cost of covering newly eligible Kansans would be $771.4 million over the first 10 years. Mosier factored in what’s called the “woodwork effect,” contending that an estimated 36,000 people who are eligible but do not use the service would seek out coverage because of the publicity of expansion. This would cost the state an estimated $455.2 million.
Those numbers combined make up about half of total Mosier quoted. That’s because she also included the cost of taking disabled Medicaid beneficiaries off the waiting lists for support services, estimated to be almost $1.2 billion over 10 years.
Rep. Susan Concannon, R-Beloit, the committee’s vice chair, objected to Mosier including this figure, calling it disingenuous. The bill does not deal with the waiting lists.
The people on the waiting lists are not waiting for health coverage. They already have it. Rather, they are waiting to receive in-home care for their disabilities.
Mosier replied that if the cost of taking people off the waiting lists is not factored in “then you’re choosing to leave the individuals on the waiting lists and actually push them down further in their wait for services.” She said that expanding Medicaid without taking care of people on waiting lists would show preference to “able-bodied adults” over the disabled.
She repeatedly emphasized that the people who would benefit from Medicaid expansion were able-bodied adults, a point also made by representatives from Americans For Prosperity, a group with ties to Koch Industries, which organized the opposition to the bill.
Concannon replied that many uninsured people dealing with illnesses also have extraordinary needs. She reiterated her contention that the waiting lists were a separate issue.
Rep. Jim Ward, D-Wichita, scolded Mosier. “How do you stand there and pit disabled people against the uninsured when you haven’t spent a dollar on the waiting lists?” he said.
Mosier replied that the state has spent $60 million to give people services and take them off waiting lists.
“We need to take care of the waiting list … that is the top priority,” Mosier said after the hearing. She said the administration had not made a decision for or against Medicaid expansion and noted she had discussed the issue with Gov. Sam Brownback on Thursday morning.
“Options for expansion are not off the table. He simply made the point that we need to take care of our individuals with disabilities,” she said.
Concannon complained about “mixed messages we get from the administration” on Medicaid expansion. She said Brownback has told lawmakers he’d be willing to consider expansion if they can come up with a plan that covers the costs. But she said now the administration is adding new costs to the mix.
“Now, we’re going to throw in the waiting lists and the woodwork effect. That’s frustrating,” she said.
The committee took no action on the bill. Rep. Dan Hawkins, R-Wichita, said that Thursday was the committee’s last scheduled hearing for the regular legislative session and that Friday is “drop-dead day” for committees to pass out bills.
Hawkins said the bill would remain alive, but he was unsure of its future. It’s possible something could happen with it during the veto session in May.
However, he said, the cost estimates Mosier provided give him pause.
“I think that’s one of the biggest things we’ve got to wrestle with,” Hawkins said. “I don’t think anybody here could debate the fact that we’ve got people out here that really need help. I think everybody understands that. It’s, how do we get there?”
Mosier’s predecessor testified in favor of Medicaid expansion on Wednesday.
Bob Moser, a doctor who served as KDHE secretary during Brownback’s first term, said that the majority of people who would benefit from expansion are part of the workforce.
“The vast majority of those in the expansion population are regular, hard-working people, some working multiple jobs,” said Moser, representing the University of Kansas Hospital. “The trouble is they are not benefits-eligible at any of those jobs. … If we can get them insurance, we also get them access to affordable health care. Access to care in turn translates to healthier families and a healthier workforce.”
Akash Chougule, a national representative for Americans For Prosperity, testified that AFP would hold accountable any lawmaker who voted for expansion, which he called a scheme.
He said expansion would drain state resources for other needs.
“Somebody has to be squeezed out if you expand this program,” he said after offering examples from other states where costs exceeded estimates.
He also said that putting insurance cards in everyone’s hand would not guarantee access to quality medical care.
Ward asked Chougule if he personally had one of those “dreaded insurance cards.” Chougule answered yes.