Coronavirus
Kansas and Missouri didn’t expand Medicaid. Could that worsen the COVID-19 pandemic?
As the single mother of a daughter with a congenital heart defect and compromised immune system, Melissa Dodge is taking every precaution she can to limit her exposure to COVID-19.
She’s cut her hours at the grocery store where she works in Derby, Kansas. When she comes home, she doesn’t touch any of her four children before changing her clothes.
Worries about illness aren’t new for Dodge, 35. She doesn’t have health insurance, and getting sick means having to calculate the risk of skipping a doctor’s visit versus paying out of pocket. The coronavirus pandemic has amplified those concerns.
“That has only increased that anxiety tenfold,” Dodge said. “The risk of getting exposed and having to manage that financially in the immediate aspect and also in the long-term as those bills start coming in… It’s a fear.”
Dodge’s children, including her 9-year-old daughter with the heart condition and 11-year-old son with autism, are covered by Medicaid, the federal-state program which provides health care for disabled and low-income families.
But Dodge is caught in the triple bind that ensnares thousands of working poor in Kansas and Missouri. She makes too much from her part-time customer service job at the grocery store to qualify for Medicaid herself. She makes too little to buy insurance through the federal health care exchange, and she works too few hours to receive benefits from her employer.
Dodge is one of roughly 130,000 Kansans and 200,000 Missourians who would be covered by Medicaid if their states had expanded eligibility under the Affordable Care Act. The change would cover adults who make up to 138% of the federal poverty line — an income of a little more than $17,600 for a single adult, or $42,300 for a family of five like Dodge’s.
Kansas and Missouri are two of just 14 states that have not expanded the program.
The decision to pass up billions in federal aid since 2014 will make coping with the novel coronavirus even more costly than anticipated, advocates contend.
It could also put the insured at greater risk, as those without health coverage remain untreated and accelerate the spread of the virus.
“It just feels like we don’t have our community’s support or our state’s support and that’s really disheartening,” said Dodge, who testified at a Kansas Senate hearing earlier this year in support of Democratic Gov. Laura Kelly’s expansion plan.
Strict requirements
Kansas currently restricts Medicaid eligibility to pregnant women, individuals with disabilities, people over 65 and low-income families with children. Parents on Medicaid can only make up to 38% of the federal poverty level — an annual income of less than $10,000 for a family of four.
The requirements are even more restrictive in Missouri. Only the disabled, children and parents with incomes under 22 percent of federal poverty — less than $5,800 a year for a family of four — are eligible.
The Kansas Legislature passed an expansion bill three years ago, but it was vetoed by then-Gov. Sam Brownback, a Republican. Kelly’s bipartisan expansion proposal has stalled in the face of GOP procedural roadblocks.
Kelly lamented Kansas’ failure to enact expansion before the pandemic in an interview this week.
“First of all, we would have been drawing down about a billion dollars more from the feds just through Medicaid expansion. So clearly that would have helped shore up our health system,” Kelly said.
One of Kelly’s closest allies in the Legislature, state Sen. Barbara Bollier, a retired Mission Hills physician, said one of her biggest concerns is that people who develop symptoms may wait longer to consult a doctor, exposing others to the virus if they don’t self-quarantine.
“A virus doesn’t check to see if you have insurance first,” said Bollier, a Johnson County Democrat running for U.S. Senate.
Uninsured Missourians brace for crisis
In Missouri, supporters of a ballot initiative to expand Medicaid had to abandon a signature campaign because of the COVID-19 outbreak. However, advocates announced Tuesday they’ve already collected enough signatures to qualify for the November ballot.
But as the virus spreads, the uninsured in both states are bracing for the worst.
Victoria Altic, a 31-year-old single mother of two who works as a restaurant cook in Springfield, makes too much for the program. Her employer doesn’t offer insurance. She said she’s trying not to panic.
Her daughter, who unlike her is covered by Medicaid, has a rare congenital brain and eye disorder that means she’s at higher risk if she comes into contact with anyone who has the virus.
“We are facing a pandemic, and everyone is more aware than ever how important it is for people to have health insurance,” she said.
“Everyone being able to afford to go to the doctor would have helped us contain this virus. Having so many people without access to health insurance left us completely unprepared for this crisis.”
James Owens, a 51-year-old father of two, has Medicaid, but whether he keeps it each month comes down to a few hundred dollars.
He does handyman jobs for clients around Kansas City, but “unfortunately I report my income honestly.” That means the harder he works, the more likely he’ll earn too much to qualify for Medicaid.
Since the outbreak, all of Owens’ business has dried up. The bills haven’t. “I had work lined up, but it all canceled. I had a couple commercial jobs, too, and again economic uncertainty led to them canceling,” he said.
“When this is over, I need to catch up. I still have to pay my other bills. I’m gonna have to work my butt off to catch up on bills,” Owens said. “So I know I will lose my Medicaid again. There’s no doubt about that. I’m gonna lose my Medicaid coverage because I have to pay bills accrued during this economic shutdown.”
‘The aftermath’ in Kansas
Patrick Sallee, CEO of Vibrant Health, a clinic in Kansas City, Kansas, that primarily serves Medicaid recipients and those in the coverage gap, said policymakers’ decision to not expand has placed all Kansans and Missourians more at risk.
“The first time it was on my radar that this virus was for sure in Kansas City is we got a call from a local health department that said we have a patient who doesn’t want to get tested because they don’t have health insurance and they don’t want to deal with the aftermath,” Sallee said.
People in the gap are less likely to have a primary care doctor to prescribe a test. The overall shortage of test kits leaves them even more cut off from care, Sallee said.
They are also more likely to hold jobs that don’t allow them to work from home, putting them at greater risk for exposure. “If McDonald’s has got to be open, that’s going to be people who fall in the gap,” Sallee said.
Congress has passed legislation to provide free testing, but not free treatment.
“The testing may be free, but then what?” said Denise Cyzman, CEO of the Community Care Network of Kansas, which represents community health centers. Cyzman said the uninsured are more likely to wait to seek treatment until the disease has progressed at which point they’ll face huge out of pocket costs.
Other costs will be passed onto hospitals facing a surge in charity care cases, said former Kansas Gov. Kathleen Sebelius, who oversaw the rollout of Medicaid expansion as President Barack Obama’s secretary of Health and Human Services.
Sebelius noted that the state has already seen three rural hospitals close since 2015, including Sumner Community Hospital in Wellington this month. In each case, the state’s failure to expand Medicaid was cited as a reason.
“I find it totally stunning that the Kansas legislature adjourned early in this session without passing Medicaid expansion. I can’t think of anything more irresponsible,” said Sebelius, who compared the economic loss from passing up the federal aid for six years to the state refusing to plant its annual wheat crop.
Strong opposition remains
Opponents of Medicaid expansion reject the notion that expansion would have better equipped the states to deal with this crisis.
“States with Medicaid expansion are suffering just as much as states without,” said Kansas House Majority Leader Dan Hawkins, a Wichita Republican. “It’s unfortunate that some people are trying to politicize this disaster to push their agenda.”
Rep. Roger Marshall, R-Kansas, argued that hospitals lose money on every Medicaid patient. The congressman initially told The Star that hospitals stood to profit from the pandemic because of the increased number of patients, but he then corrected himself and said his comments were insensitive.
“In actuality, hospitals are going to be losing money because of this virus and the reason is they’re shutting down elective surgeries… so you’re right this is going to be a huge impact on their bottom line,” said Marshall, an OB-GYN from Great Bend and candidate for U.S. Senate.
Still, he said, “Medicaid expansion would never have helped,” and pointed to the $100 billion in aid to hospitals included in Congress’ $2 trillion coronavirus relief bill as a more significant help to hospitals at this time.
Americans For Prosperity, a free market advocacy group with ties to Wichita’s billionaire Koch family, argued that expansion exacerbates the strain health care providers are already facing.
“There’s really no part of Medicaid expansion which increases the number of available healthcare providers or facilities,” said Elizabeth Patton, director of Americans for Prosperity-Kansas.
Republicans in the Missouri state legislature have long argued that expanded Medicaid eligibility will blow a hole in the state’s budget and require cuts to other areas, like public education.
This opposition inspired organizers of the Missouri ballot measure to forgo simply changing state law and to instead ask voters in November to enshrine expansion in the state constitution. That will limit the ability of lawmakers to block or reverse the plan in the future.
The debates in Topeka and Jefferson City are likely to continue whenever the legislatures reconvene. That won’t do much for those facing tough choices right now.
David Larson, a 56-year-old Wichita resident, said that a friend took him to see a doctor when he came down with influenza last month and paid the $185 out of pocket.
“I was just planning on sticking it out and trying to feel better,” said Larson, a former minister who draws a $12,000 annual income from his 10 hours a week at the National Alliance for Mental Illness in Wichita and a death benefit from his late wife’s pension.
Larson, who has clinical depression, said he’s secluding himself to avoid catching the virus. But if he does contract it, he’s unsure of how he’ll pay for treatment.
“A lot of us are just going to suffer,” he said.
The Kansas City Star’s Jason Hancock reported from Jefferson City. The Wichita Eagle’s Jonathan Shorman reported from Topeka.
Comments