Guest Commentary

There’s no widespread public demand for Medicaid expansion

Michael Austin

Special to The Wichita Eagle

As Kansas lawmakers consider the governor’s proposal on Medicaid expansion it’s important to understand what it is and how it will impact Kansans. Medicaid expansion is a part of the Affordable Care Act, also known as ObamaCare. With it, states can expand Medicaid coverage for able-to-work, childless adults making below federal poverty income limits. However, the extra government spending on expansion does not go to traditional Medicaid patients, such as pregnant women, disabled persons and children, to name a few.

A commonly used statistic by many is that 77 percent of low-income Kansans favor Medicaid expansion. Proponents argue because of overwhelming public demand the government needs to expand Medicaid coverage. However, there is no wide-reaching public demand for Medicaid expansion. In fact, a recent poll showed that 54 percent of Kansas voters do not want Medicaid expanded, preferring other ways to make health care more affordable. The poll was conducted by SurveyUSA, who received an “A” grade from FiveThirtyEight and is used by several media outlets. They also found an additional 22 percent of Kansas voters want expansion paid for by reducing spending in other areas. Gov. Laura Kelly wishes to push forward with Medicaid expansion, with no long-term pay-fors, even though most Kansas voters don’t want that.

Nearly every state that has expanded Medicaid have largely underestimated the number of able-to-work, childless adults that signed up. On average, expansion costs have more than doubled predictions. As an example, the state of Louisiana, an expansion model promoted by Kelly, missed their enrollment by 100,000.

Kelly suggested raiding highway funds, supported by only 9 percent of Kansas voters, delaying pension payments, and denying 100 percent of Federal Tax Reform to pay for their estimate on Medicaid expansion. Kansans have dealt with four tax increases in the past four years, and yet the state is still running a $600 million shortfall. Are Kansans willing to accept more tax hikes if expansion costs double?

We found most Kansas voters said no.

However, we shouldn’t lose sight of the most important concern about Medicaid expansion: Does it improve the health outcomes better than the alternative? Unfortunately, the answer is no. Research studies show no discernible improvement in health outcomes from expansion compared to private or no insurance. Meanwhile, the diversion of state spending from traditional Medicaid puts the health of the neediest patients at risk. Fewer available taxpayer dollars mean longer wait times and a higher chance of never getting proper care.

There is needed discussion about ways to make healthcare more affordable. However, the constant drumbeat that Medicaid expansion is the only path makes it hard to find sensible solutions. Productive conversations about alternatives like association, short-term health plans or expanded tele-medicine for rural populations must not be drowned out by expansion advocates. Kansans need public pressure to fix our expensive health care system that isn’t limited to just one policy. Kansans express a desire to have policy debates move beyond partisan sound bites and strive to solve real problems.

Michael Austin is the director of the Sandlian Center for Entrepreneurial Government

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