While a few serious issues continue to be debated in committee and the courts, basically the 2022 legislative session is a wrap. And once again, Medicaid expansion didn’t pass.
True, the legislature agreed upon an expansion of the postpartum health coverage offered under KanCare to new mothers, which is an important step. But the broader expansion of Medicaid, the one embraced by 38 states (including every state that borders Kansas), the one supported by nearly 80% of Kansas voters, is still firmly opposed by a majority of the Republicans those voters sent to Topeka. Why this is the case remains puzzling. One reason may be the misinformation about Medicaid expansion frequently spread by Republican leaders--often intentionally, but also sometimes due to their own confusion.
The traditional conservative line against expanding Medicaid coverage to people who have no medical insurance through their low-paying jobs and cannot afford private insurance, but still aren’t poor enough to meet KanCare’s strict requirements, is that doing so would increase the number of “able-bodied” people receiving government assistance, and that’s bad. That position can be argued with, of course, but at least it reflects an ideological position familiar to Kansans.
Lately though, leading Republicans have also taken to claiming that Medicaid expansion must be fought in order defend those Kansans already on Medicaid. Representative Dan Hawkins, the Republican majority leader in the Kansas House, recently made this case, insisting that in states which have expanded Medicaid high enrollments have “crowd[ed] out other state budget priorities,” lengthened waiting lists, and left those states with “less to spend on things like education and public safety.” These claims either lack context or are simply incorrect.
It is true that Medicaid enrollments in the states which have expanded their programs have been far higher than anticipated, especially during the pandemic. But the evidence for Rep. Hawkins’s other claims is very thin. Medicaid expansion, it must be remembered, was part of the overall reform of American health care which the Affordable Care Act created over a decade ago, and taps federal resources to cover Medicaid costs. An extensive study of the budgets in all states where Medicaid has been expanded--published by the non-partisan Commonwealth Fund--concluded that the budgetary burden of Medicaid payments in most of those states actually declined, even with higher than estimated enrollments. And whatever additional costs and bureaucratic transitions came with managing those Medicaid applicants, they were almost never large enough to threaten existing programs or force tax increases to maintain balanced budgets.
Hawkins’s warning about people dying while waiting for treatment under Medicaid in expansion states sounds worrisome—until you remember similar tragedies characterize waiting lists in non-expansion states. When dealing the health needs of the working poor and disabled, there’s always plenty of frightening statistics available. But pitting those currently receiving KanCare assistance against those Kansans struggling to survive on incomes that put them below the poverty line misses the whole point of Medicaid in the first place.
Ultimately, when Hawkins writes that “expansion in Kansas will result in the same outcome as it has in every other state where it has been implemented,” he’s actually arguing in favor of a positive change. My recommendation to anti-expansion Republicans like Hawkins, therefore, is to stick with their well-understood, Brownback-era, anti-welfare and libertarian arguments. Trying to claim that the policy changes which Medicaid expansion would entail for some Kansans receiving its assistance is itself an argument for denying of it to other equally needy people simply doesn’t work.
Dr. Russell Arben Fox teaches politics in Wichita.