Katy Everitt, a hair stylist with a 9-year-old son is battling cancer without health insurance and believes the state should expand eligibility for Medicaid to lower-income Kansans such as herself. (Tim Carpenter/Kansas Reflector)
An ongoing series on the states that refuse to expand Medicaid. Read other project stories.

TOPEKA — Master hair stylist Katy Everitt learned during the pandemic that cancer thought to be in remission had spread to her liver.

The 36-year-old Topekan has no health insurance, but she cobbled together an approach to treatment following the initial diagnosis of ovarian cancer in 2014 that relied on her limited ability to pay, generosity of health professionals, participation in clinical trials and a reservoir of hope. She’s fighting the disease for herself and her son, 9-year-old Titan.

About ‘The Holdouts’

Her frustration at not being eligible for Medicaid assistance in Kansas — she would be eligible in Colorado, where she lived 10 years ago — was palpable in a recent interview at a coffee shop a couple blocks from the state Capitol.

If Kansas agreed to broaden enrollment of uninsured adults in KanCare, she would have regular access to doctors and treatments that would, even if the cancer remained, improve her quality of life.

“It’s mind-boggling. The excuses blow my mind,” she said. “I’m very bitter.”

Political Calculus

The Republican-led Kansas Legislature, in collaboration with GOP Govs. Sam Brownback and Jeff Colyer, successfully blocked expansion of eligibility for Medicaid for the past eight years. Opponents have questioned the quality of health care available under Medicaid and also opposed reform on philosophical, financial and political grounds.

Advocates pointed to the necessity of delivering health care to Kansans who are unable to afford private insurance. Proponents also refer to the economic benefit of hundreds of millions of dollars in federal funding and the jobs created by Medicaid expansion.

Over the years, 38 states and the District of Columbia embraced provisions of the Affordable Care Act to add lower-income adults to Medicaid. The holdouts: Kansas, Texas, South Dakota, Wyoming, Wisconsin and the Southern states of Alabama, Georgia, Mississippi, Tennessee, South Carolina, North Carolina and Florida.

Democratic Gov. Laura Kelly proposed legislation in February that would provide Medicaid services to an estimated 150,000 Kansans without access to affordable health care. It would deliver coverage to Kansans earning up to 138% of the federal poverty level starting Jan. 1, 2023. In 2021, Kelly recommended use of medicinal marijuana revenue to finance Medicaid expansion. Neither bill made it to the finish line.

“It’s time to work together to deliver for Kansans and get this done once and for all,” Kelly said. “Expansion would inject billions of dollars into our state, create thousands of jobs, help retain our health-care workers in Kansas and help rural hospitals’ bottom lines.”

Under federal law, the U.S. government was obligated to pay 100% of increased costs to states of Medicaid expansion from 2014 to 2016. That figure dropped to 95% in 2017, 94% in 2018, 93% in 2019 and 90% in 2020. However, incentives woven into the American Rescue Plan Act sweetened the deal for reluctant states.

Expansion legislation has been derailed in Kansas despite a statewide survey indicating 78% of respondents wanted to grant more Kansans access to a continuum of affordable coverage options under Medicaid.

The Legislature, led by Republican House Speaker Ron Ryckman and Republican Senate President Ty Masterson, has declined to override GOP leadership on Medicaid reform.

Masterson has maintained Medicaid expansion could be detrimental to the state’s budget, limit health-care access to people with disabilities and the elderly, and increase individual health-care costs for people on private insurance. Instead, he advocated for better access to telemedicine services and removal of regulatory barriers placed on nurse practitioners. Both of those ideas were adopted by the Legislature in 2021 or 2022.

‘Save My Life’

Everitt said she was convinced a portion of Kansas politicians formed negative stereotypes of people such as herself to justify their opposition to Medicaid expansion. She appreciates some politicians consider her an able-bodied adult angling for taxpayer-funded health care.

She realized not every legislator would come around to her view, but she theorized some would change their mind if they had to personally experience a life-threatening illness without health insurance.

“You know someone very closely in your life, I guarantee it, that has this problem,” she said. “They must think that anyone who needs Medicaid must be out with five kids, all different dads, doing drugs on their free time, not working or not wanting to work.”

A reality of the hair styling business, Everitt said, is people get paid only when working. A person out sick due to chemotherapy treatment doesn’t get a paycheck. The industry rarely provides affordable health insurance to staff, she said, but her son benefitted from health insurance through his father.

Everitt said moving to a state that had expanded Medicaid eligibility was an option if the oral chemotherapy regimen she was on didn’t keep the cancer confined to the liver.

“We’ve talked about that before,” she said. “To save my life, we would do it. If I have to, I will, which is sad. I love Kansas.”

This story is part of “The Holdouts,” a reporting collaborative focused on the 12 states that have yet to expand Medicaid, which the Affordable Care Act authorized in 2010. The collaborative is a project of Public Health Watch.