For six years now, the issue of whether to expand Medicaid, the state/federal health insurance program for low-income citizens, has surfaced every legislative session in Kansas only to suffer defeat.
In 2017, backers were hopeful when legislators approved expansion, only to have then-governor Sam Brownback veto it.
So today, despite the fact that 75 percent of Kansans approve Medicaid expansion, it remains out of reach for approximately 152,000 of our working poor, or at least as long as its the responsibility of todays current makeup of legislators. In Maine, the issue is on the November ballot. And because Kansans continue to shell out their federal tax dollars for other states to enjoy the extended insurance benefits, perhaps their patience will start to wear thin and demand that they, too, should have a direct voice in the matter. To date, Kansas has forfeited more than $2.8 billion in federal funds that would increase Medicaids outreach.
LAST MONDAY, health care experts met in Lenexa to argue, for the most part, why Kansas should expand Medicaid based on an in-depth study that compared health outcomes between Kansas and the states of Indiana and Ohio.
Sponsored by the REACH Healthcare Foundation, The Commonwealth Fund, a New York-based private foundation focused on health care, and the Harvard T.H. Chan School of Public Health, the symposium discussed the study, led by Dr. Ben Sommers, an internist and associate professor at Brigham & Young Womens Hospital and Harvard Medical School in Boston.
Sommers discussed Kansas current plight.
More than 20 percent of our poor ages 19 to 65 remain uninsured, compared to 14 percent and 15 percent respectively for Indiana and Ohio.
Among Kansans statewide, the health insurance rate is 87 percent.
In Kansas, a family of four can subsist on no more than 38 percent of the federal poverty level, or $9,063, to qualify for Medicaid.
In states that have expanded Medicaid, their umbrellas of coverage extend to those who make up to 138 percent of the federal poverty level, or about $16,000 for an individual, or $34,000 for a family of four. (In Kansas, individuals without children do not qualify for assistance of any kind unless they are disabled.)
The difference in coverage means that in states such as Ohio and Indiana, a family never has to go without the option of affordable insurance. Either they can receive Medicaid because they make within $34,000 a year or they can apply for insurance through the Affordable Care Act, whose coverage for a family of four begins at an annual income of $32,913.
In Kansas, that $24,000 income gap for a family of four is never closed and available resources remain out of reach.
The damage to our people, our healthcare institutions, and our future, is stunningly stark compared to states that have expanded Medicaid.
The difference?
Poorer health, premature death rates, higher rates of poverty.
Think about it, if you lack adequate means, then you put off things like going to a physician or getting your prescriptions regularly filled.
Patients who cant fill their prescriptions or have to make one months supply last two months, have worse outcomes, said Sommers. Thats not going to manage their diabetes. Thats not going to manage their high blood pressure or heart disease.
As a physician, Sommers said he serves as a gatekeeper.
For those who have a primary care physician, thats their entry point into healthcare. The alternative entry point is the emergency room or no care, options that are much more costly to not only ones health but also their pocketbook.
IN THEIR interviews with more than 3,000 low-income Kansans, researchers found that one-in-three respondents had put off the decision to see a physician because of the financial strain it would cause, Sommers said. For those who live in states that have expanded Medicaid, about 25 percent of respondents said routine medical care remained a financial challenge.
As to their perception of whether their quality of care might suffer under Medicaid, Sommers said respondents didnt differentiate between that and private insurance. They just want some kind of health insurance, he said. If they can get coverage, its less important than how they are getting it.
Sommers referred to the state of Arkansas, which agreed to expand Medicaid but directs the federal subsidies to private insurance companies.
Same outcomes, he said. The big picture is whether to expand Medicaid.
This is not an empty benefit, Sommers said. Its actually leads to real benefits for real people.
In states that have expanded Medicaid, theres a 10 percent increase in diabetics getting their glucose regularly monitored.
If you dont check your glucose regularly, you cant be controlling your diabetes well, he said.
Insurance is pathway for people getting on medications that they need for a long time. he said.
In states without expansion, one of three patients with chronic conditions such as diabetes say they dont regularly visit a physician.
Of the 33 states that have expanded Medicaid, visits to primary physicians have increased resulting in better health outcomes; fewer report a delay in filling prescriptions because of their cost; and fewer wait until the last minute to receive care, typically at their hospitals emergency room.
Perhaps most importantly, Sommers said, is the positive change in peoples perceptions of their health once they have these advantages.
Now you may ask if that matters. In fact, thats a question I am regularly asked by policy makers: Is it worth the investment of public dollars and policy changes? Well, let me say two things: First, Im a doctor and if you tell a patient that you dont care if hes feeling better, you should probably stop taking care of patients.
And I suggest policy makers should take the same approach. If a policy leads people to feel better, thats probably a good investment.
The inverse is also true, Sommers said. The mortality rate of people who say they are in poor health is five to 10 times higher than those who say they are in excellent health. So when someone tells you they are in poor health, you should believe them.
MEDICAID also covers the elderly poor, including those who are in nursing homes. Under Kansas law, individuals with more than $2,000 in savings must spend down that income on their health care before Medicaid becomes applicable for long term care.
In states that have expanded Medicaid, individuals are allowed to keep multiple times more in savings before they receive Medicaid benefits.
FOR THOSE who say Kansas cant afford to expand Medicaid, Sommers said the states component would equal to less than 1 percent of the state budget, or about $74 million of its $29 billion budget, according to the State of Kansas, Department of Administration.
For 2019, the federal governments subsidy would be 93 percent of expansion costs, and 90 percent in 2020 and beyond.
Currently, the federal government pays 57 percent toward Kansass Medicaid program, which covers low-income children, low-income disabled adults, pregnant women, and parents with incomes under 38 percent of poverty.
One reason its not prohibitively expensive to provide for this additional population under expansion is because these people typically arent as sick as the adults already on Medicaid based on their disability status, Sommers said.
The budget pressures on Medicaid are largely not about its expansion, but rather about the overall demands of complex care, long-term care and Americas aging population.
That extra 1 percent to the state budget is unlikely to be the straw that breaks the camels back, he said.
In the 33 states that have expanded Medicaid, none of them have repealed it. None have backtracked, he said.
In fact, Arkansas and Kentucky have experienced savings after expanding Medicaid because of the additional federal dollars.
In 10 years time of deferring Medicaid expansion, Kansas will have lost $5.3 billion in federal funds.
Sommers also said expanding Medicaid is increasingly a non-partisan issue. There are some ruby red states that have expanded it. Medicaid touches the lives of more people than any other program.
Not all healthcare experts agree with Sommers assessment.
As part of a panel that followed Sommers presentation, Jon Hamdorf, Director of Medicaid for Kansas, questioned whether access to healthcare should be a right, much like the right to vote or right to free speech, and wondered Why were not having that conversation, instead.
I dont have the answer to that, he said, but suggested instead of spending time on all the micro issues of how Medicaid expansion could work in Kansas, we should instead focus on the macro issue of whether Kansans should provide for their poorer and disadvantaged populations.
For those on the panel whose careers are devoted to delivering healthcare, no matter ones financial status, they did not reply.
