Arguments for Medicaid expansion in Kansas have been made over the past several years using sound economic, budgetary and public health rationales. They have collapsed, however, under the reflexive antipathy toward the Affordable Care Act of Gov. Sam Brownback and conservatives in the Legislature.
The result: Tens of thousands of Kansas’ workers go without health insurance compared to states that expanded Medicaid, according to a study by Families USA. Expansion states, on average, saw a 25 percent decline in their rate of uninsured workers, compared with just 12 percent for Kansas – a difference of more than 2 to 1.
It shouldn’t be this way. State and federal partnerships, such as Medicaid expansion, have a history of success and have been a hallmark of Republican governance for more than a century.
Start with the Land Grant College Act of 1862, sponsored by Justin Morrill – a founder of the Republican Party – and signed by Republican President Abraham Lincoln. Under the act, the federal government gave states federal land they could manage or sell to endow colleges specializing in agriculture and engineering – as happened at Kansas State University. The states would pay for the construction and maintenance of the schools.
Another example of a joint state/federal enterprise is the Federal Aid Highway Act of 1956, proposed by Republican President (and proud Kansan) Dwight Eisenhower.
Medicaid expansion is in the best tradition of these historic partnerships. Helping low-income Kansans get health care is an investment in human capital every bit as important to our future as building universities and roads.
In Kansas, Medicaid is very restrictive. Parents of dependent children cannot receive coverage if their incomes exceed a meager 38 percent of the federal poverty level, about $638 a month for a family of three. Other adults – singles and childless couples – can’t get coverage even if they have no income at all.
Medicaid expansion would extend eligibility to adults with incomes at or less than 138 percent of the federal poverty level – or about $2,130 a month for a family of three.
The majority of the expansion population – about 150,000 in Kansas – are working men and women who earn too much to qualify for traditional Medicaid but not enough to be eligible for subsidies on the health care exchange.
The federal government would pay 95 percent of the cost in 2017, sliding to a permanent 90/10 ratio by 2020 – the precise split of the Highway Act.
The Legislature should revisit Medicaid expansion during this year’s session with a vision that extends beyond short-term election cycles. It should look out toward the horizon and generations yet to come – as great Republican leaders like Lincoln and Eisenhower did.
Ron Pollack is executive director of Families USA, a health care advocacy organization in Washington, D.C.