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Passions High On Both Sides Of Kansas Medicaid Expansion Debate

Jim McLean
Heartland Health Monitor

The recent legislative hearings on Medicaid expansion brought representatives from dozens of powerful groups to the Kansas Statehouse.

Lobbyists representing hospitals, doctors and some big businesses pleaded with members of the House Health and Human Services Committee to approve an expansion proposal one day.  The next day representatives of conservative, anti-tax organizations urged committee members to continue to say ‘no’ to expansion, despite the billions of additional federal dollars it would inject into the Kansas economy.

But the hearings also attracted scores of everyday citizens. They included those who need the coverage that expansion would provide and others opposed to extending benefits to non-disabled adults.

Mary Weber is a single mother of three who works as a para-professional in the Wichita school district. She helps students with disabilities keep up in the classroom.

Weber’s children qualify for Medicaid – known in Kansas as KanCare – but she doesn’t. Adults with dependent children must earn less than one-third of the federal poverty level to be eligible for KanCare. That translates into about $8,000 a year for Weber’s family of four.

At the same time, Weber’s annual income isn’t enough to qualify her for federal subsidies that would all but cover premiums for private coverage purchased in the Affordable Care Act marketplace. She’s caught in what has come to be known as the Medicaid expansion gap.

“I make too much for Medicaid and not enough for the ACA (tax credits),” Weber said.

Weber had health problems that sent her to the hospital last year. The care she received cost about $1,200 and she couldn’t pay the bill.

“For a single mom, that’s a lot,” she said. “I ended up having to pay for part of it, but the hospital wrote off a big chunk of it.”

The need for such write-offs has been lessened in states that have expanded their Medicaid programs to cover adults earning up to a third more than the federal poverty level – about $16,000 for individuals and nearly $33,000 for families of four.

But many Kansas hospitals have seen their “charity care” numbers climb at the same time that they are dealing with reductions in Medicare payments.

Weber said she understands that Medicaid expansion is a politically charged issue because of its connection to Obamacare.  But from her perspective, the politics are blinding legislators to the fact that expansion could provide coverage to about 150,000 Kansans, most of whom are now uninsured.

Weber stuttered as she searched for a respectful way of expressing her frustration.  But after a few stops and starts she gave up and said what was on her mind.

“It’s a bunch of crap,” she said. “That Medicaid expansion would give a lot of us who do work and who are trying to make a living the health insurance we need.”

Credit Jim McLean / Heartland Health Monitor
Heartland Health Monitor
Walter Cunningham, Wichita, recently traveled to the Statehouse to oppose a bill that would expand Medicaid eligibility to more poor, non-disabled adults.

Walter Cunningham also has strong opinions on the issue. He was one of several people who attended the hearings wearing green T-shirts that said “Light the Fire of Freedom in Kansas” on the front and “Ideas Don’t Work Unless You Do” on the back. The shirts were supplied by Americans for Prosperity Kansas, a conservative group with ties to Wichita’s Koch brothers that lobbies for smaller government.

Cunningham, also from Wichita, said welfare benefits make people too dependent on the government. He cited his adult daughter as an example.

“I have a daughter who chose obesity and chose to smoke to the point where she ended up losing a part of her leg (to diabetes),” Cunningham said. “She’s now on kidney dialysis. She has no insurance. So she’s plaguing the system.”

His daughter receives about $1,000 a month in Social Security disability benefits, Cunningham said.

“I told her not to take any of the money and ‘you can come die with us because that’s what you’re going to end up doing,’” he said.  “So, the government – Social Security and Medicare – have given her a cushion, which she did not deserve.”

The lobbyists for AFP and conservative think-tanks who spoke against expansion weren’t as blunt as Cunningham but there were echoes of his objections in their testimony.

“Medicaid expansion, in my opinion, is morally indefensible because it puts able-bodied folks in line ahead of the disabled. The arguably not-needy ahead of the truly needy,” said Dean Clancy, a Washington, D.C., veteran of conservative causes who now works for the Florida-based Foundation for Government Accountability.

The disabled Kansans on Medicaid waiver waiting lists that Clancy referred to actually are receiving medical care. However, they are waiting for Medicaid support services to help them live independently.

Eliminating the waiting lists appears to be a prerequisite for Republican Gov. Sam Brownback, though it would add hundreds of millions of dollars to the state’s share of expansion costs. 

That reality appears to make it even less likely that Kansas lawmakers will seriously consider a bill backed by the Kansas Hospital Association that requires the Brownback administration to craft an expansion proposal and negotiate its approval with federal officials.

The chairman of the HHS committee, Wichita Republican Dan Hawkins, has said he has no immediate plans to schedule a vote on the bill.

Jim McLean is executive editor of KHI News Service in Topeka, a partner in the Heartland Health Monitor team.

Jim McLean is a political correspondent for the Kansas News Service, a collaboration based at KCUR with other public media stations across Kansas. You can email him at jim@kcur.org.
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