$1.6B offered to Kansas and Missouri for Medicaid expansion, but GOP doesn’t want it
The number of patients visiting Health Partnership Clinic in Olathe and Paola dropped nearly a third last year as the pandemic took hold. And yet, the number without insurance surged by 10% and is still growing.
Officials there, and at similar Kansas and Missouri clinics serving low-income patients, say such numbers highlight a burgeoning need for Medicaid expansion. It would provide health coverage to hundreds of thousands of people across both states who make too much for Medicaid but not enough for subsidies under the Affordable Care Act.
“Without Medicaid expansion, real people, hardworking people, are being hurt,” Health Partnership Clinic CEO Amy Falk said at a roundtable discussion Wednesday.
Congress and President Joe Biden last month handed expansion supporters a large incentive designed to sway resistant lawmakers in Kansas, Missouri and 10 other holdout states. A $1.9 trillion spending package signed into law by Biden provides the states hundreds of millions to kick-start expansion, directly taking aim at objections that states can’t afford to increase the size of the programs.
Over two years, Kansas could receive up to $450 million; Missouri could get $1.15 billion, according to estimates from the Kaiser Family Foundation.
But the federal offer has had little effect in Kansas and Missouri, where Republican-controlled legislatures are largely ignoring the money. Lawmakers have just weeks left in their annual sessions and progress on expansion so far has proven difficult.
“It’s like when a drug dealer offers the first hit of a drug for free knowing that you’ll be addicted and coming back for more,” Kansas House Majority Leader Dan Hawkins, a Wichita Republican, said in a statement.
Expansion would raise eligibility for Medicaid to 133% of the federal poverty level, or $26,500 a year for a family of four. In Kansas, upwards of 130,000 residents would likely enroll. A state law prevents the governor — currently Democrat Laura Kelly, an ardent expansion supporter — from moving forward without the Legislature’s authorization.
Last year, Kelly forged an expansion deal with some top Republicans, but it became collateral damage in a fight over abortion. This year, the governor has proposed authorizing medical marijuana to pay for expansion. Lawmakers are seriously considering it, but it’s unclear whether the Legislature will be able to pass a bill this year.
In Missouri, voters approved expansion last August, mandating it in the state constitution. But House Republicans have balked at funding it, leaving open the possibility the General Assembly will approve a budget without enough money to cover the additional 275,000 residents expected to enroll.
“The federal government is making it even dumber than before to not expand,” Kelly said Wednesday during a visit to HPC with Democratic U.S. Rep. Sharice Davids to tout the federal incentive.
“We are sending money out to D.C. that absolutely should be coming back here to help the 165,000 people in our state, our neighbors, our loved ones, to get the access to affordable quality health care that they need,” Davids said. “And the American Rescue Plan has done just that. There’s a way that at the federal level we can incentivize states like Kansas to expand Medicaid.”
Kansas and Missouri Republicans have either sidestepped questions surrounding the funding or point to it as a reason not to expand.
Hawkins said the federal government’s move to “sweeten the deal to get states to accept so-called free money, that’s a clear indication it’s a terrible idea.”
He said throwing more money at the program won’t change that taxpayers will have to pay for “welfare to cover able-bodied adults who choose not to work” and put the state on the hook for another entitlement program “we will be stuck paying for long after these federal funds are gone.”
Kansas Rep. Troy Waymaster, a Bunker Hill Republican who chairs the House budget committee, said “we’ve got to be careful before we bite” on the additional funding.
“So yeah, would it pay for itself the 10% cost share to the state? For a while, yes it would,” Waymaster said. “But then eventually we’re still going to be held with being responsible for that later on.”
Missouri Republicans have also maintained that the one-time funding isn’t enough to cover what they say will be ballooning future costs of the program expansion. Missouri House Budget Chair Cody Smith, a Carthage Republican, has said he believes the population that enrolls could nearly double in future years.
“I think it is foolish to say that because we have a temporary revenue available because of a very unique situation … that now we can act as though we have money that we can spend,” Missouri Rep. Doug Richey, an Excelsior Springs Republican, said in the House Budget Committee last month. “That is not a way to plan and to address long-term issues.”
Republican Gov. Mike Parson’s office did not say whether the state should try to claim the incentives by expanding Medicaid.
“There are many unknowns” about whether the General Assembly will ultimately fund the expansion, spokeswoman Kelli Jones said.
Missouri Democrats have repeatedly pointed to the incentives during debate, but House Republicans voted down multiple attempts to restore state funding for the expansion or use the incentives to pay for it.
“If this potential investment were for anything else, for infrastructure, for workforce development, for education, we would jump at the chance and consider ourselves infinitely blessed,” Rep. Sarah Unsicker, a Shrewsbury Democrat, said last week. “People play a lottery for this kind of windfall.”
At Health Partnership Clinic, officials say expansion would provide a significant financial boost. An additional $800,000 to $1.3 million would come into the clinic each year, Falk said.
About 20% of the clinic’s patients would benefit, she said.
“I’ve talked a lot about the numbers,” Falk said. “But at the end of the day, it really comes down to Kansans taking care of Kansans.”
The Star’s Katie Bernard contributed reporting
