How this GOP lawmaker realized Kansas should expand Medicaid
When I was first elected in 2016, I was hesitant about expanding Medicaid in Kansas, like many of my fellow Republicans. We have all heard the myths about how it would ruin our state, and I shared in those fears at first: the anxiety that it means much bigger government, with intimidating fiscal obligations that could break the bank. And what would happen if the federal government ended the program?
But after studying the issue, listening to both sides and researching what other states have done, I not only voted for expansion both in 2017 and 2018 — I became an expansion advocate.
Let me break down some of the myths and share the reasons that changed my mind and heart:
Myth: Kansas can’t afford expansion.
Truth: Expanding KanCare is fiscally responsible and better for our economy.
The state of Kansas can afford it. The program is budget neutral, and would likely prove budget-positive because it would produce a net savings for the state. The federal government gives states $9 for every dollar they spend on Medicaid expansion. Kansas’ cost would be approximately $40.5 million in 2019, meaning we would get $365 million from the federal government.
That $40.5 million is offset by reducing the state’s cost of many Medicaid services we already pay for that are reimbursed by expansion, for a total net savings of approximately $58.5 million. By 2020, the state’s costs would reach approximately $109.8 million, giving us $988 million in federal funding. The revenues and savings would total up to $114.5 million.
Myth: Expansion wouldn’t impact the Kansas City metropolitan area.
Truth: Not expanding is costing us billions.
The status quo is costing Kansans $1.8 million per day, resulting in a total forfeiture of more than $3 billion in federal funding and counting, according to the Kansas Hospital Association. Kansas is now among a very small minority of states (just 14) that use their own funds to pay for Medicaid expansion elsewhere, rather than investing that money into the health of our own residents, our own hospitals and our own economy.
Thirteen Johnson County hospitals lose more than $33 million per year in uncompensated care that would be reimbursed under Medicaid expansion. KU Health System’s main campus loses $24 million that would be covered. Johnson County government spends roughly $4 million, with $3 million of that on reimbursable mental health services.
Myth: Expansion is a handout to the unemployed.
Truth: The vast majority of those eligible are full-time workers.
Many of these workers have low-income jobs that do not provide health coverage, or that offer coverage that is too expensive. The idea of the able-bodied freeloader is a myth. Of those who don’t work, a majority are not healthy enough to work consistently because of chronic illness or disability, are caregivers for children or are senior adults. (It is very difficult to qualify for Social Security disability. A large number of Kansans with disabilities that make it difficult for them to work have not secured disability status.)
Myth: Congress is going to eliminate Medicaid expansion in the future.
Truth: Expansion is not going anywhere.
The strongest argument against expansion is the supposedly looming threat of the federal government ending or significantly reducing the reimbursement. If either of those happen, we have introduced an escape route to end state funding as well. Moreover, even when Republicans controlled the White House and both chambers of Congress, they showed that expansion was untouchable. Congress did not consider ending it or reducing the federal match. Republican governors of states with expansion lobbied against ending it. It’s here to stay.
Working Kansans and their families desperately need access to health care and the financial flexibility that access brings. We’ve seen Republican- and Democratic-led states across the country reach consensus on Medicaid expansion to benefit their people, communities and economies. It’s time Kansas does the same.
Republican Tom Cox represents the 17th District in the Kansas House of Representatives.