Medicaid expansion would benefit Missouri, Kansas

05/02/2014 3:47 PM

05/03/2014 6:11 PM

I'm afraid I don't understand the math that legislators in Missouri and Kansas are using when they refuse to expand Medicaid.

The taxes the Feds impose to pay for Medicaid expansion don't go away if a state refuses to expand. Missouri's and Kansas' tax dollars are simply going to fund the states that did expand Medicaid. The federal government in the Patient Protection and Affordable Care Act, also known as Obamacare, said it would pay 100 percent of Medicaid expansion until 2016 and then still pay 90 percent of the expansion.

The Kaiser Family Foundation calculated that Kansas is forgoing about $5 billion of federal funds over the next 10 years by refusing to expand Medicaid. Missouri is giving up almost $18 billion.

But, the losses don’t stop there. Part of the way that Obamacare controls costs is with incentives to hospitals to reduce re-admissions. But fewer admissions mean less money for hospitals.

That money was expected to be made up by the increased payments by Medicaid. One Topeka hospital says that failing to expand Medicaid is already costing it $10 million per year. Truman Medical Center estimates it will lose $150 million in the next seven years without Medicaid expansion.

The Kaiser Family Foundation says that Kansas and Missouri are voluntarily giving up $2.5 billion and $7.5 billion over the next 10 years. These direct costs to Kansas and Missouri don't include the human costs of continuing to have hundreds of thousands of uninsured people who could be covered by Medicaid.

When these people do seek care, it is often at the state's expense through the uncompensated care funds. Add a few hundred million dollars to the bill to Kansas and Missouri.

But, the uninsured uniformly also have worse health outcomes than those with insurance, so we can expect that tens of thousands of people will go without needed care. A study published in Health Affairs in January, for example estimated that more than 6,000 Kansans would forgo diabetes medications.

From 100 to 300 people a year would die from this and other conditions that go untreated for lack of Medicaid coverage. The numbers for Missouri are about double that.

The Aon Hewitt study that Kansas Gov. Sam Brownback commissioned said Medicaid expansion would cost about $600 million over the next 10 years. The study calculated $1.1 billion in additional spending over the next 10 years minus the $500 million that Kansas would have to spend on “woodwork” Medicaid recipients whether it expands Medicaid or not.

That $600 million figure is similar to what other studies have said, (Kaiser Family Foundation — $525 million, Kansas Health Institute — $519 million). For Missouri, Kaiser Family Foundation estimates $1.5 billion for the next 10 years. So, Kansas is balking at $600 million and Missouri at $1.5 billion over 10 years that could pay a return of $7.5 billion and $25.5 billion?

Could someone please explain the sense in this?

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