Rural Kansans’ lives depend on Medicaid. But DC politicians are threatening it | Opinion

In the public debate over Medicaid expansion in Kansas, a critical fact often gets lost: Large numbers of our state’s residents already depend on the program.

What’s more, despite racist stereotypes, those benefiting from the program live mostly in rural areas.

A new report from Georgetown University’s Center for Children and Families sketches the present system and makes clear the threat of potential Medicaid cuts from Congress. A menu of potential spending reductions from U.S. House Budget Committee chair Rep. Jodey Arrington slashes $2.3 trillion — yes, that’s with a “t” — from the program covering low-income Americans, Politico reported.

“Medicaid is really the backbone of so many aspects of our health care system, from birth to long-term care, and many stops in between,” said Joan Alker, executive director and co-founder of the center. According to surveys, “this is literally the last thing voters want — voters of all political parties.”

As lawmakers in Washington, D.C., prepare a massive tax cut and spending bill, it seemed worthwhile to learn about what Medicaid means to rural areas. It also seemed worthwhile to learn about what it means for Kansas. Again: The program already covers Kansans of all ages. Alker and Benjamin Anderson, the president and chief executive officer of Hutchinson Regional Healthcare System, joined me on the Kansas Reflector podcast to sort through the issues.

Anderson told me the program is absolutely vital.

“A disproportionate share of seniors, of moms and and children in our area receive health care through Medicaid, and some of them represent the working poor,” he said. “We are a state that has not expanded Medicaid, but children in in Kansas, it is a significant source of access for them. And so, when parents have a sick kid who can’t access health care, those parents can’t work, and when they can’t work, then we see economic impacts for that as well. It’s an essential partner, specifically around maternal child health, and then also with caring for seniors.”

The report, based on information from the Census Bureau’s 2023 American Community Survey, stresses several key findings to bolster that perspective:

• Of kids in small towns and rural communities, almost 41% receive coverage through Medicaid. In metropolitan areas, 38% do.
• Of adults under age 65 in small towns and rural communities, about 18% receive coverage through Medicaid. In metropolitan areas, the figure is 16%.
• In areas with large numbers of tribal residents (American Indian or Alaska Native), those of all ages are likelier to be covered by the program.

In Kansas, 32.3% of kids in rural areas are covered by Medicaid or CHIP, compared to 28.7% of metropolitan-area kids. Also, 11.9% of seniors in rural areas are covered by Medicaid, while 11.3% of seniors in metropolitan areas are covered.

“From birth to seniors, Medicaid is a vital source of health insurance to our residents, covering more Kansans in rural communities,” said April Holman, executive director of the Alliance for a Healthy Kansas, on the report. “Additionally, this report makes clear that Medicaid is an important stable revenue source for hospitals and providers in rural Kansas, ensuring that we can access health care when and where we need it.”

Anderson spoke about his experience at Kearny County Hospital in Lakin. More than half of the births at the hospital were covered by Medicaid. Without that safety net, mothers wouldn’t have had access to prenatal care. Without prenatal care? Untold numbers of mothers and babies would suffer.

The effects on older adults are similarly far-reaching.

“They essentially deplete their resources before the end of their life,” Anderson said. “And these are people that diligently save, but people are living longer than they have, and just circumstances come up where that’s happened. And Medicaid is the backstop for skilled nursing. When we start compromising that infrastructure, and they can’t get into skilled nursing, they end up in our emergency department. There is well-documented evidence that among those vulnerable populations, over 50% of the health care spent in that person’s life is in their last six months. If we think we’re going to save by cutting this, we have a rude awakening coming.”

Taking a broader view, that means that Medicaid cuts have a negative multiplier effect, Alker said. If the federal government carves trillions out of the program, states will be forced to fill the gap. No one wants to see old people or children dying in the streets. But that means other services will suffer.

“This is going to impact education. It’s going to impact transportation, roads, law enforcement, everything in the state’s budget, because states will be left holding the bag,” she told me. “And it’s an absolutely untenable situation. They simply can’t manage their way out of this.”

Anderson characterized himself as a right-of-center conservative concerned about the deficit. But given his knowledge of the health care sector, he said, these types of cuts simply won’t have their intended effect.

“We’re only going to send people into the (emergency department) and spend more federal money in Medicare to offset it,” he said.

“There are ways to incentivize work,” he added. “There are ways to incentivize healthy families. This ain’t it, to use a west Kansas phrase.”

My discussion with Alker and Anderson proves a point that I’ve made repeatedly. Officials in Kansas and Washington, D.C., have to find ways to separate partisanship from policy. While Medicaid might not be perfect — we chatted about various reforms that could strengthen the program — it serves an invaluable role in the same rural communities that voted for the new president.

We all have a duty to care for those in need during their darkest hours. That duty transcends creed or party. It goes to the very core of what makes us human.