TOPEKA — Teacher and writer Chandra Dickson stepped to a microphone in front of a big crowd at the Capitol on behalf of her mother Jo Anne, who worked long hours in the service industry but earned too much to qualify for Medicaid and too little to afford private health insurance.
“My mother had chronic asthma and later in life also developed diabetes,” said Chandra Dickson, of Wichita. “She would often put her health care needs last.”
The daughter said Jo Anne Dickson was excited about passage of the Affordable Care Act in 2010 and the prospect of states expanding access to Medicaid coverage to lower-income people once major provisions of the law took root in 2014. But, to her dismay, Kansas politicians in Topeka never agreed on a plan to expand eligibility for Medicaid, known as KanCare in Kansas.
In 2016, Jo Anne Dickson was diagnosed with an aggressive form of non-Hodgkin lymphoma. Her family came up with $500 for an initial treatment for the cancer, but she died eight days later at age 62.
“If my mother had qualified for KanCare, she would have gotten the routine health care that she desperately needed and that she would still be here with myself and my daughter,” Chandra Dickson said. “I miss her every single day. I tell her story in memory because she would want me to, because we would not want any other Kansan to go through what my family went through.”
More than a decade after President Barack Obama signed the ACA in law, Kansas sits among 11 states that have rebuffed expansion.
In 2017, then-Gov. Sam Brownback vetoed a Medicaid expansion bill. The Kansas House passed another expansion bill in 2019, but that was derailed in the Kansas Senate. GOP leaders in the Senate have forbidden a committee hearing on a Medicaid expansion bill since 2020.
A series of four public opinion polls of Kansans indicated 72% to 78% of those surveyed supported expansion of access to quality health care.
“Unfortunately, there is a disconnect between the will of the public and what is happening in this building when it comes to KanCare expansion,” said April Holman, executive director of Alliance for a Healthy Kansas. “We need expansion to reduce health care costs for everyone, protect against medical debt, fix outdated and unrealistic Medicaid eligibility limits, preserve and strengthen rural health, help more people to be healthy enough to rejoin or remain in the workforce and help Kansas compete economically with our neighbors.”
Kansas Among 11 Holdouts
Gov. Laura Kelly, who has annually renewed her call for broadening eligibility for Medicaid to 100,000 to 150,000 people, said Kansas had so far turned aside $6 billion in federal funding that would have accompanied Medicaid expansion. She said acceptance of expansion in Kansas would create 23,000 jobs, help address the state’s workforce shortage in health care and strengthen the financial status of 75 hospitals vulnerable to closure.
“It’s no wonder every single other state surrounding us has expanded Medicaid,” she said. “We just have to make sure the legislative leadership gets the message.”
She said prospects were bleak during the 2023 legislative session because Republican leaders of the House and Senate weren’t interested in negotiating a compromise Medicaid expansion bill. Senate President Ty Masterson and House Speaker Dan Hawkins, both Wichita Republicans, have been clear in their opposition to the legislation.
Thirty-nine states and the District of Columbia have expanded access to Medicaid under the Affordable Care Act. Earlier this month, North Carolina revealed a plan to expand Medicaid in 2024. In addition to Kansas, holdouts west of the Mississippi River include Wyoming and Texas.
Political opposition to expansion in Kansas solidified among Republican politicians under Brownback. He signed a bill requiring the Legislature to approve expansion rather than leave the issue to the executive branch and a possible Democratic successor, such as Kelly.
Kansans are no stranger to Medicaid, because the program is the third-largest provider of health coverage in Kansas. It trails Medicare and Blue Cross Blue Shield of Kansas.
As of January, Medicaid covered 539,000 Kansans through a network of three for-profit companies under contract with the state. Medicaid is the single largest insurer of children in Kansas, with youth amounting to 60% of all served. Medicaid paid for about 40% of births in Kansas. Medicaid also provided funding for a large portion of mental health services delivered across the state.
‘A Moral Indictment’
Physician Roy Jensen, vice chancellor and director of the University of Kansas Cancer Center and a member of the national board of directors for the American Cancer Society’s Cancer Action Network, said one of the highest priorities of the Cancer Action Network was expanding Medicaid to states that objected to improving health care delivery.
He offered a series of sobering statistics to illustrate the value of early intervention Medicaid expansion would provide tens of thousands of Kansans.
“If you are unlucky enough to be without insurance of any type on that day that you are diagnosed with cancer, five years from that date there is a 50% decreased likelihood that you will be alive,” Jensen said. “That’s an astounding statistic and its a moral indictment of not expanding care.”
He said lower-income women in states that expanded Medicaid were 25% more likely to receive screening mammograms than low-income women in states that had not expanded Medicaid. In addition, he said lower-income individuals in states that expanded Medicaid had a 6.1% reduced mortality rate.
“This is about saving lives. And, it’s a measurable difference. We need to get past the politics and make this happen,” Jensen said.
In 2021, the federal American Rescue Plan created an extra incentive for states to consider the issue. Kansas, if it adopted Medicaid expansion, would qualify for an estimated $370 million to $450 million in additional federal funding over the next 2½ years. In other words, additional funding from the federal government would be sufficient to cover the state’s share of expansion for about eight years.
Debate about expanding eligibility for Medicaid in Kansas centered on whether to expand services to low-income adults 18 to 65 years of age. The expansion population would include adults with household incomes up to 138% of the federal poverty rate. In a household of one, that income limit would be $20,000 per year. A family of four would have an annual income limit of $41,400.
Curtis Sneden, president of the Topeka Chamber of Commerce, said there were personal health and financial reasons to support expansion of Medicaid. The Topeka chamber’s members were convinced to speak out for another reason, he said.
“The state’s failure to expand KanCare, put simply, is bad business,” Sneden said. “Placing the burden of uncompensated health care on our health care system, when the solution is so straightforward, that’s bad for business.”
This story is part of “The Holdouts,” a reporting collaborative focused on the 11 states that have yet to expand Medicaid, which the Affordable Care Act authorized in 2010. The collaborative is a project of Public Health Watch.