Kansas Senate Vice President Jeff King is taking issue with Governor Sam Brownback’s reasons for opposing Medicaid expansion.
Melika Willoughby, Brownback’s deputy communications director, outlined those reasons in an Oct. 6 email to supporters. Referring to expansion as a “masquerading component of Obamacare, Willoughby said the governor believes it would “morally reprehensible” for the state provide health coverage to low-income Kansans “who choose not to work” before providing support services to all of the disabled Kansans now on waiting lists.
In addition, Willoughby accused expansion supporters of “lying” by claiming that the additional federal funding expansion would have generated might have prevented the closure earlier this month of Mercy Hospital in King’s hometown of Independence.
In a response posted on his website Thursday, King pushed back. He said contrary to Willoughby’s assertion, the “vast majority” of uninsured Kansans who would be eligible for coverage under expansion are “working adults and students.”
“I refuse to make moral judgments based on a person’s view of Medicaid expansion. I wish Ms. Willoughby would have done the same,” he continued. “Maybe if her hospital was closing. Maybe if her parents were wondering where to go for emergency care. Maybe if she faced uncertainty is her health care future, she would view those looking for health care answers in a little less judgmental light.”
King, a self-described conservative Republican and former expansion opponent, now supports the kind of private-sector approach being taken in other Republican-controlled states.
“We are looking at using federal funds to help small businesses provide private health insurance for their employees and assist colleges in getting private insurance for their students,” King wrote. “Conservative states like Indiana have shown that this can work. Far from expanding ‘government-run health care,’ the Indiana model and those like it expand private health care, limiting the role of government.”
Indiana’s expansion plan, approved by federal officials in January, uses Medicaid dollars to purchase high-deductible health insurance plans for adults making up to 100 percent of the federal poverty level, or $11,770 for individuals and $24,250 for a family of four. The state then contributes money to a Personal Wellness and Responsibility, or POWER, account that beneficiaries can use to cover out-of-pocket costs. The Indiana plan also requires beneficiaries to contribute to the account.
If there’s going to be a serious discussion about expansion, it will because King and other Republican leaders have decided they could pay a political price for ignoring it.
“Our health care system failed Independence and it is failing tens of thousands of hard-working Kansans,” King said in the column posted to his website. “I don’t have all the answers, but saying no to everything isn’t an option.”
However, many Republican legislative leaders remain opposed to expansion. A talking-points memo they recently commissioned to sharpen their arguments says that costs have far exceeded estimates in many expansion states. And it also asserts that the low-income adults who would gain coverage under expansion are capable of taking care of themselves.
“The population Medicaid expansion would cover consists of healthy adults without children who could receive private coverage if they work 33 hours a week at the minimum wage,” the memo says, referring to the income level at which people can qualify for federal tax credits to help them purchase coverage on the Affordable Care Act marketplace.
KanCare eligibility limits
Brownback privatized the Kansas Medicaid program in 2013. Now called KanCare, the nearly $3 billion program is administered by three managed care organizations.
KanCare now covers about 425,000 low-income children and families, plus disabled and low-income elderly adults. Adults with dependent children are eligible for KanCare coverage only if they have incomes below 33 percent of the federal poverty level, annually $7,870 for a family of four.
Non-disabled adults without children aren’t eligible regardless of income. Expansion would extend KanCare coverage to non-disabled, childless adults with incomes up to 138 percent of poverty: annually $16,105 for an individual and $32,913 for a family of four. Though policymakers could decide to follow the Indiana model, which expanded eligibility only to those earning up to 100 percent of the poverty level.
Jim McLean is executive editor of KHI News Service in Topeka, a partner in the Heartland Health Monitor team.
