Guest Commentary

Bridget McCandless: Not expanding Medicaid leaves us all behind

Bridget McCandless is the President and CEO of the Health Care Foundation of Greater Kansas City.
Bridget McCandless is the President and CEO of the Health Care Foundation of Greater Kansas City.

For the last eight years, we have watched our elected officials introduce and debate nationwide health care legislation. We advocated during deliberations that any bill should protect our citizens with the least means and the most health needs.

When the Affordable Care Act passed, but the Supreme Court struck down the Medicaid expansion mandate, the Health Care Foundation of Greater Kansas City advocated for expansion in both Kansas and Missouri.

We have always advocated for better access and better quality of care. We are again advocating that any changes to the current health care coverage protect the most vulnerable around us.

The Affordable Care Act, while far from perfect, has resulted in substantial declines in the number of people in our community who are uninsured, across the U.S. down from 18 percent to 10 percent. In the years since the ACA was passed, the number of uninsured people in Kansas and Missouri has decreased by nearly 300,000. Had Missouri and Kansas expanded Medicaid, that number would total closer to an estimated 700,000 Kansans and Missourians who could access quality health care.

Against this backdrop, the foundation appeals to our elected leaders to preserve what has worked about the ACA and improve upon what hasn’t.

There are countless opportunities for new legislation to better our health care. For starters, the bill could include prevention strategies that would reduce our country’s health care costs, which continue to grow at a clip that far outpaces the economy. We can reduce said costs by preventing chronic diseases before they start. The public health community has the tools to create environments for everyone to eat healthy, live actively, and avoid tobacco and other harmful substances.

The health insurance marketplace is another critical piece of our health insurance coverage system, but it has failed to stabilize as envisioned. Rather than resulting in choice and competition, the marketplaces have seen dwindling numbers of insurers and increases in premiums that make coverage unaffordable for too many. Certain financial tools in the ACA were intended to stabilize the private insurance market and slow the growth of premiums over time. However, they were never funded by Congress. Following through on that funding would be an immediate system improvement. Ensuring the continuation of cost-sharing reductions would be another.

Instead of discussing these viable solutions, conversations surrounding the American Health Care Act have legislators scrapping much of what worked about the ACA. Most alarmingly, the AHCA would impose per capita caps on Medicaid and reduce Medicaid funding by more than $830 billion over 10 years. This represents a fundamental shift in the construction of our health care safety net, a system that has been in place for more than 50 years.

Block grant proposals have the potential to freeze health care access at a moment in time. It will be the equivalent of hitting the “pause” button in our states: We will be frozen as we are — without Medicaid expansion and with low eligibility levels. Other states that have expanded Medicaid and eligibility, like Kentucky and Iowa, will have the advantage and may receive more federal funding. Once again, we will be left behind. We will receive less federal Medicaid funding, and our consumers and health care system will suffer.

Block grant proposals have a real possibility to increase barriers to health for the vulnerable in our community. Medicaid is a little-understood program, but it is a huge support for so many folks in our community.

It is important, as this debate progresses, that we encourage our federal delegation to think of the long-term goals we all share: people healthy enough to work, raise families and fully participate in their communities.

Bridget McCandless is the president and CEO of the Health Care Foundation of Greater Kansas City.