The inaugural edition of a Heritage Foundation news site features an interview with Kansas Gov. Sam Brownback explaining “how Obamacare’s Medicaid expansion hurts states.”
The interview is featured in the Daily Signal, a new online publication “supported by the resources and intellectual firepower” of the foundation, which describes its mission as promoting “conservative public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense.”
But that openness wasn’t apparent in the Heritage interview. Asked why Republican governors in Iowa, Indiana, Pennsylvania and other states were moving forward, Brownback said: “There is a lot of pressure to do it. And there is this presentation that this is free money from the federal government.”
Just last week Brownback told reporters in Topeka that he remains “open to Medicaid expansion,” adding that he was monitoring attempts by Republican governors in other states to take a more private-sector approach to expanding coverage.
Brownback said he believes his “wait and watch” strategy remains the best course of action because he isn’t convinced that the federal government will live up to its obligation to pay 100 percent of expansion costs for the first three years and not less than 90 percent thereafter. Mounting federal debt will make it impossible, he said.
“Do you think that a fiscally solid, prudent state like the state of Kansas is going to end up with a 90/10 ratio on Medicaid when the federal government is staring at that much cost? They’re going to up our percentage,” Brownback said.
Watching the interview Tuesday on a laptop in his Topeka office, Sean Gatewood, director of the Kansas Medicaid Access Coalition, hit the pause button.
Every state budget that the governor has signed contains federal money for highways, education and public health programs among other things, Gatewood said. Brownback and Republican leaders also have aggressively lobbied for billions of federal dollars to construct the National Bio and Agro-Defense Facility on the Kansas State University campus.
“I keep hearing this and I don’t understand,” said Gatewood, a former Democratic legislator from Topeka. “That 90 percent match is federal law.”
“So, why is this one (Medicaid expansion) singled out? That’s the question,” Gatewood said.
The concerns about federal funding could be addressed in legislation authorizing expansion by including a trigger that would automatically roll back Medicaid eligibility to current levels if federal funding ever fell below the promised 90 percent threshold, Gatewood said.
But, Gatewood said, whenever he proposes the fix to expansion opponents, they come up with other objections.
“It just seems to be a front,” he said. “Even when the objection is overcome there is still something else there.”
Other expansion supporters reacted negatively to Brownback’s explanation of why he decided to focus on extending Medicaid services to Kansans with physical and developmental disabilities over expanding eligibility for the program. In the interview, Brownback differentiated between “needy” disabled Kansans waiting for services and “able-bodied, single” adults whose best path to coverage is a job.
“We’re trying to push people who are able-bodied right now to get a job,” he said. “That is a far more likely route out of poverty than having a bunch of government programs giving handouts to able-bodied individuals.”
Krista Postai, who runs one of the largest safety net clinics in the state, Community Health Centers of Southeast Kansas, said the governor is perpetuating divisive stereotypes to deny Medicaid to poor, working Kansans who can’t afford private coverage.
“He appears to be building on the stigma of there being some able-bodied people out there who don’t want to work and who lie around at the expense of those who do work,” Postai said. “I don’t understand the logic of somehow going after those people by not letting people who are working have access to Medicaid. It makes no sense to me.”
A December 2013 report published by the nonpartisan Kaiser Family Foundation said that nationally 54 percent of people in the so-called Medicaid coverage gap have jobs. They earn too much to qualify for Medicaid in Kansas and the other 18 states not implementing expansion but too little for federal subsidies to help them buy private coverage on the Obamacare exchange.
“He appears to be building on the stigma of there being some able-bodied people out there who don’t want to work and who lie around at the expense of those who do work,” Postai said. “I don’t understand the logic of somehow going after those people by not letting people who are working have access to Medicaid. It makes no sense to me.”
Approximately 80,000 uninsured Kansans are in the Medicaid gap.
Currently, most of the approximately 380,000 Kansans enrolled in Medicaid – called KanCare – are children, new mothers, the disabled and seniors in nursing homes. Able-bodied adults are eligible only if they have dependent children and earn less than 33 percent of the federal poverty level (FPL), which for a family of four is $7,770 annually. No matter their income, Kansas adults without children aren’t eligible unless they are disabled.
Expansion would extend Medicaid coverage to all those earning less than 138 percent of FPL – about $32,500 annually for a family of four.
Dave Ranney contributed to this report.
Jim McLean is executive editor of KHI News Service, an editorially independent reporting program of the Kansas Health Institute.
