Brownback's Medicaid study not the full story

The consulting firm commissioned by Kansas Gov. Sam Brownback estimates the state will spend $1.1 billion over the next 10 years if it expands its Medicaid eligibility to the level called for in the Affordable Care Act.

If Kansas leaves its Medicaid limits where they are — at the miserly level of 32 percent of the poverty level for adults with children — expenses will increase by $513 million over the 10-year period, according to the Aon Hewitt firm.

Expanding Medicaid eligibility to 133 percent of the poverty level would bring about 226,003 children and adults into the program and enable them to get regular medical care.

The Aon Hewitt study falls somewhere in the middle of what a few other studies predicted it would cost the state to expand Medicaid.

But — and this is a big omission — I haven’t yet seen a study out of Kansas that includes offsets. What would the state save in mental health costs, for instance, by getting that population into Medicaid? Would it save money on uncompensated care expenses to hospitals? Is the state paying health care for disabled citizens and other populations who could be covered by Medicaid?

In Missouri, Gov. Jay Nixon’s budget experts tallied up these offsets and figured the state would come out with a net gain by expanding Medicaid.

Also missing is any study of the economic impact of a Medicaid expansion. The Missouri Hospital Association led the way on that front, but the Kansas Hospital Association has been much meeker, for some reason. What would Kansas gain in economic benefits by bringing billions of dollars into the state to expand its health care networks? And what will be the impact on Kansas hospitals if hospitals if they must continue to care for uninsured patients once the federal government cuts off compensatory payments?

Brownback hasn’t yet said what he’ll do about expanding Medicaid, but a statement from his office Friday did not bode well.

“For Kansas to expand the Medicaid program as the ACA requires, the state would need more than $1 billion dollars in new expenditures,” Sherriene Jones-Sontag said.

“This impact would be significant and would directly affect the ability of the state to fund other core responsibilities like K-12 education and public safety. And if the federal government fails to keep its promise to pay for its part of the expansion, the direct impact would be even greater.”

Setting aside the irony of Brownback’s decision to decimate the state’s ability to fund core services with his income tax cuts, one has to wonder why the governor doesn’t consider health care for working Kansans who can’t afford insurance and don’t receive it from their employers to be a core responsibility.