Needed: An honest analysis of Medicaid expansion in Missouri and Kansas
The Kansas City Star
The U.S. Supreme Court ruling upholding the constitutionality of the individual insurance mandate in President Barack Obama’s health reform law also handed a huge decision to state governments.
Suddenly it was optional, not mandatory, for states to increase their Medicaid eligibility limits to 133 percent of the poverty level, as called for in the Affordable Care Act.
In the Republican-controlled capitals of Kansas and Missouri, where “Obamacare” is about as welcome as a flu epidemic, leading politicians are loath to consider an expansion.
Tim Jones, Missouri’s new House speaker, said as much recently. A spokeswoman for Kansas Gov. Sam Brownback indicated “serious concerns” about the state’s share of costs.
Before leaders rule out expanding Medicaid eligibility, however, they owe it to constiuents to obtain a thorough and honest analysis of the impact. Some preliminary studies indicate states may come out ahead financially.
Assessing the impact is a complicated task.
Even the first step — determining how many people would qualify under the expanded limits — is difficult.
A free-market group, the Kansas Policy Institute, calculated that 253,000 additional Kansans would receive Medicaid if the limits were expanded. Schrammraleigh Health Strategy, an actuarial firm commissioned by the former Kansas Health Policy Authority, came up with a much lower number: 121,000.
What’s certain is that expanded limits would help large numbers of people, especially in Missouri, where adults can earn no more than 19 percent of the federal poverty level to qualify for Medicaid. In Kansas, the limit is 26 percent of the federal poverty level.
The Affordable Care Act calls for the federal government to pick up the full costs of the expanded Medicaid programs for three years, beginning in 2014. After that, Washington would pay for 90 percent of the expansion.
Opponents in both states say even picking up their 10 percent share would be too burdensome. But that assertion is premature without taking into account other factors.
Some of the biggest ones:
The Affordable Care Act calls for a phaseout of payments the federal government gives to states to help hospitals that serve significant numbers of low-income, uninsured patients. Missouri hospitals collectively received almost $800 million this year.
Loss of that money, without more patients gaining insurance, would be disastrous for the budgets of hospitals and entire communities.
Expanding Medicaid limits would extend coverage to many low-income people who receive state mental health services, relieving states of that cost.
Missouri and Kansas currently pay health care costs for disabled populations that would be covered under the expanded Medicaid limits. One example is Missouri’s Blind Pension Fund, which spends about $28 million a year to provide health care for low-income blind people. Most of them would be Medicaid-eligible under the new limits.
An expansion of Medicaid would bring millions of dollars into both states for hospitals, clinics and health professionals. An economic impact study by the University of Nebraska Medical Center calculated that federal spending on a Medicaid expansion would finance more than 10,000 jobs in Nebraska each year though 2020.
The most important factor is the most difficult to put a price tag on. Missouri and Kansas have the opportunity to offer thousands of residents the security of a medical home and care when they need it.
The alternative is to leave those people in a medical doughnut hole, unable to access services that are available to people with incomes above and below theirs.
Under no scenario would that be healthy.