TOPEKA — Master hair stylist Katy Everitt learned during the pandemic that cancer thought to be in remission had spread to her liver.
The 36-year-old Topekan has no health insurance, but she cobbled together an approach to treatment following the initial diagnosis of ovarian cancer in 2014 that relied on her limited ability to pay, generosity of health professionals, participation in clinical trials and a reservoir of hope. She’s fighting the disease for herself and her son, 9-year-old Titan.
Her frustration at not being eligible for Medicaid assistance in Kansas — she would be eligible in Colorado, where she lived 10 years ago — was palatable in a recent interview at a coffee shop a couple blocks from the state Capitol.
If Kansas agreed to broaden enrollment of uninsured adults in KanCare, she would have regular access to doctors and treatments that would, even if the cancer remained, improve her quality of life.
“It’s mindboggling. The excuses blow my mind,” she said. “I’m very bitter.”
Political calculus
The Republican-led Kansas Legislature, in collaboration with GOP Govs. Sam Brownback and Jeff Colyer, successfully blocked expansion of eligibility for Medicaid for the past eight years. Opponents have questioned the quality of health care available under Medicaid and also opposed reform on philosophical, financial and political grounds.
Advocates pointed to the necessity of delivering health care to Kansans who are unable to afford private insurance. Proponents also refer to the economic benefit of hundreds of millions of dollars in federal funding and the jobs created by Medicaid expansion.
Over the years, 38 states and the District of Columbia embraced provisions of the Affordable Care Act to add lower-income adults to Medicaid. The holdouts: Kansas, Texas, South Dakota, Wyoming, Wisconsin and the Southern states of Alabama, Georgia, Mississippi, Tennessee, South Carolina, North Carolina and Florida.
Democratic Gov. Laura Kelly proposed legislation in February that would provide Medicaid services to an estimated 150,000 Kansans without access to affordable health care. It would deliver coverage to Kansans earning up to 138% of the federal poverty level starting Jan. 1, 2023. In 2021, Kelly recommended use of medicinal marijuana revenue to finance Medicaid expansion. Neither bill made it to the finish line.
“It’s time to work together to deliver for Kansans and get this done once and for all,” Kelly said. “Expansion would inject billions of dollars into our state, create thousands of jobs, help retain our healthcare workers in Kansas and help rural hospitals’ bottom lines.”
Under federal law, the U.S. government was obligated to pay 100% of increased cost to states of Medicaid expansion from 2014 to 2016. That figure dropped to 95% in 2017, 94% in 2018, 93% in 2019 and 90% in 2020. However, incentives woven into the American Rescue Plan Act sweetened the deal for reluctant states.
Expansion legislation has been derailed in Kansas despite a statewide survey indicating 78% of respondents wanted to grant more Kansans access to a continuum of affordable coverage options under Medicaid.
The Legislature, led by Republican House Speaker Ron Ryckman and Republican Senate President Ty Masterson, has declined to override GOP leadership on Medicaid reform.
Masterson has maintained Medicaid expansion could be detrimental to the state’s budget, limit health care access to people with disabilities and the elderly, and increase individual health care costs for people on private insurance. Instead, he advocated for better access to telemedicine services and removal of regulatory barriers placed on nurse practitioners. Both of those ideas were adopted by the Legislature in 2021 or 2022.
