“This proposal includes elements of my plan, of Senator Denning’s plan, of the 2019 House plan, and of the bipartisan plan that passed both chambers in 2017,” Kelly stated in a news release.
Under the compromise, announced January 9, 2020, Kansas would seek a Section 1332 waiver for creating a state reinsurance program, impose an annual hospital “Medicaid expansion support” surcharge up to $35 million, create “a robust work referral program” by referring unemployed enrollees to a job training program, and require enrollees to pay a monthly premium of $25 a month. No enrollees would be locked out of the program for failing to pay the premium—instead, the unpaid premium would be referred to the state’s debt setoff program. There would also be a hardship provision, for enrollees unable to pay.
A Love Hate Relationship
Kansas has grappled with Medicaid expansion since the introduction of Obamacare. In 2017, lawmakers passed an expansion bill, but then-Governor Sam Brownback (R) vetoed it. In 2019, expansion was approved by the Kansas state house but defeated in the state senate. That same year, while considering expansion, Kansas sought a work requirement and 36-month cap, but the Centers for Medicare and Medicaid Services rejected the cap and Kansas postponed the work requirement request.
If the proposal is implemented, Kansas would become the 38th state (including the District of Columbia) to expand Medicaid. Obamacare allows states to expand their Medicaid programs to include able-bodied people up to 138 percent above the poverty level. The federal government covers 90 percent of the costs, higher than traditional Medicaid.
Kelly said expansion will keep the state financially stable.
“It’s long past time to expand Medicaid so that more Kansans have access to affordable health care, our rural hospitals can stay open, and the tax dollars we send to Washington can come back home to Kansas to help our families,” Kelly stated.
Expanding Medicaid can be a fiscal trap, even with so-called “free market protections,” says Matthew Glans, senior policy advisor to The Heartland Institute, which publishes Health Care News.
“This proposal, like many of the faux free-market plans passed in other states, allows for the expansion of a failed program and all the costs and waste it can create,” Glans said.
Kansas has proposed a reinsurance plan to control costs, but Glans says it is not a fail-safe.
“While both popular and an effective tool for managing costs, reinsurance programs like those being considered in Kansas only serve to stabilize Medicaid and do little to address the real issues with the program,” Glans said. “Reinsurance creates a high-risk pool for insurers so they can cover claims from higher-cost individuals, reduce premiums and attract healthier people. They do not address the unnecessary mandates, rules, and continually-growing costs involved with Medicaid.”
Glans says there are other flaws with the Kansas proposal.
“The lack of a work requirement, an essential reform, is concerning, as is the lack of any penalty for those failing to pay the premium, which makes any premium far less effective,” Glans said.
Ashley Bateman ([email protected]) writes from Alexandria, Virginia.
Kansas Bipartisan Medicaid Expansion Bill Summary: https://governor.kansas.gov/wp-content/uploads/2020/01/Medicaid-Expansion-Bill-Summary.pdf