Barbara Shelly

Barbara Shelly: Gov. Sam Brownback takes the low road on Medicaid expansion

Gov. Sam Brownback
Gov. Sam Brownback

In Kansas Gov. Sam Brownback’s world, expanding Medicaid eligibility to more low-income Kansans would create “new government entitlements” for “able-bodied adults” and benefit a small number of “big city hospitals.”

I’ll say this for Melika Willoughby, the deputy communications director who penned that incendiary language in an email on behalf of the Brownback administration: She’s got the code words down pat.

The idea of creating a new welfare benefit for able-bodied slackers in big city (read: urban) locales is enough to cause a run on anxiety meds among some Kansans who are fortunate enough to afford them. Members of the state Legislature already are lining up for refills.

By spewing this sort of vitriol, the governor’s office is choosing to argue a complex issue with the lowest forms of talking points. A recent memo to legislators from the staff of House Speaker Ray Merrick veered in the same ugly direction.

One can argue against expanding Medicaid on fiscal grounds. Some of the states that have broadened their eligibility are finding that more people are enrolling, and costs are higher than they’d estimated. But those states are finding ways to reduce and offset the new costs, and not one has reversed its expansion.

And, given that the recent closing of a rural hospital is prompting this renewed debate, one can make a case that the financial problems of rural hospitals are multifaceted and Medicaid expansion is not a guaranteed means of salvation. But it would surely help. The Kansas Hospital Association estimates the average rural hospital would receive $1.32 million a year in new federal funds from expansion.

Of course most of the expansion money would go to larger hospitals in the state’s more populous areas, simply because they serve more Medicaid patients. But shouldn’t Brownback, Merrick and other political leaders be concerned about the fiscal health of all the state’s hospitals?

The most offensive portion of Willoughby’s memo was this sentence: “Medicaid expansion creates new entitlements for able-bodied adults without dependents, prioritizing those who choose not to work before intellectually, developmentally and physically disabled, the frail and elderly and those struggling with mental health issues.” The governor, she said, finds that “morally reprehensible.”

It’s correct that most of the people who would benefit from an expansion of Medicaid to the level called for in the federal Affordable Care Act are adults without dependents. That’s because they currently can’t qualify for Medicaid at all. But research has shown two-thirds of new Medicaid recipients would come from the ranks of the working poor.

They would not be jumping the line ahead of truly vulnerable Kansans. People with physical and developmental disabilities already are covered for medical needs under the KanCare program. Elderly Kansans who are indigent can qualify for Medicaid.

As for the mentally ill, no group would benefit more from Medicaid expansion. Surveys have found that more than half of the people who seek treatment at Kansas community mental health centers are uninsured.

After he decimated state services with disastrous income tax cuts, Brownback isn’t fooling anyone with his sudden concern for disabled Kansans, who still face long waits for support services.

“To pit two groups of vulnerable people against each other — that is the lowest I’ve seen,” said Tom Laing, executive director of InterHab, an advocacy group for developmentally disabled Kansans and their families.

Morally reprehensible, is what it is.