Davis Merritt: Kansans could pay for Brownback ideology

Judging by his actions – or lack thereof – Gov. Sam Brownback believes that his only obligation to the people of Kansas is to protect us, at any cost, from the overreaching federal government.

Why else would he reflexively oppose the Affordable Care Act and fail to expand Medicaid, on the federal dime, for about 150,000 Kansans? And why refuse to set up a state health insurance exchange? And why support the lawsuit aimed at gutting the ACA?

Surely his reasons could not be so shallow as personal ideology or mollifying his contributors, for that could never justify the damage to Kansans he has wreaked and may wreak in the future.

And that would make him just another one-dimensional political hack. Since that cannot possibly be so (after all, Kansans twice elected him governor), one must assume he believes:

▪  That some quarter of a million Kansans in poor and economically marginal families are better off without health insurance and increased Medicaid coverage.

▪  That Kansans would rather see higher health insurance premiums than suffer the indignity and moral weakness of dealing with the federal government.

▪  That Kansas hospitals are so flush with cash that they are happy to continue treating uninsured people in emergency rooms and trying to pass along or eat the uncompensated cost.

▪  That insurers will quietly swallow their losses rather than raise premiums and cut benefits if the ACA is gutted.

In such a Brownbackian fantasy world, he and his legislative acolytes might be tempted to dance a victory jig should the U.S. Supreme Court this summer declare illegal the federal subsidies that enable even poorer people to buy health insurance in states (like Kansas) that refused to set up exchanges.

But they would be dancing right off a steep cliff and taking most Kansans with them.

Here’s why:

If the 80,000 lower-income Kansans who bought policies through the federal exchange lose the average $214-per-month federal subsidy they qualified for, a huge portion will have to drop out. That’s bad enough. But add to that the broader ripple effect that would collapse the state’s health insurance market. Insurers participating in the federal exchange based their rates for all their policies on the assumption that the $1 billion per month in subsidies would be there. Without that income, some companies will drop out and all of them will have to raise premiums substantially for everyone.

Theoretically, Brownback and the Legislature could fix that:

▪  By replacing the federal subsidies. But they already face a $600 million shortfall for the next fiscal year because of Brownback’s reckless 2012 income tax cuts. Replacing the federal subsidy would cost another $205 million a year.

▪  By finally establishing a state exchange. But the federal subsidies – and insurance policies – would be lost immediately, while creating an exchange could take at least two years and $40 million. Federal startup grants used by 16 smarter states to set up exchanges are long gone.

▪  By persuading Congress to fix the part of the ACA the court overrules. Good luck with that in a U.S. House of Representatives that has voted 67 times to repeal the whole act.

A bad court decision in June would lock in the damage from Brownback’s ideological intransigence. That’s nothing to dance about.

This story was originally published March 9, 2015 at 7:01 PM with the headline "Davis Merritt: Kansans could pay for Brownback ideology."