The House Health and Human Services Committee tabled a bill that would expand Medicaid, and Rep. Dan Hawkins declared it “dead,” the same day. However, Democratic representatives used a procedural move to revive it. The full House voted to expand Medicaid on Wednesday.
In committee, 160 individuals testified in support of the legislation. Five people testified against expanding Medicaid.
Though House lawmakers passed the bill with a wide majority, 81-44, they debated the measure at length before sending it to the Senate for consideration. The legislation may require a veto-proof majority in both chambers to become law. It passed three votes short in the House.
The Costs
Gov. Sam Brownback said expanding ObamaCare is “bad for Kansas” and “unaffordable.” The fiscal note attached to the legislation estimates it would cost the state $53 million next year.
The Kansas Department of Health and Environment estimates expanding KanCare will cost the state as much as $1.1 billion by 2020, and an independent actuarial study estimated the cost at $1.2 billion through 2025. The Kansas Health Institute, a nonprofit organization, estimates Medicaid expansion would cost the state $729.7 million over the next seven years.
Other States
Michael Tanner, a senior researcher at the Cato Institute, testified against the proposal in a House committee hearing. In other states, he warned, enrollment figures exceeded estimates, “in most cases by double digits and in some cases by more than 100 percent.”
Thirty-one states expanded Medicaid under ObamaCare with stunning results.
“In neighboring Colorado, the maximum projected enrollment was 187,000 and as of October of last year, enrollment had exceeded 446,000,” Tanner’s written testimony reads.
The situation isn’t unique to Colorado. Every state that made enrollment projections on Medicaid expansions under Obamacare has missed the mark by an average of 110 percent. Kentucky enrollments doubled projections.
In Ohio, 715,000 able-bodied adults signed up for its expansion program. To date, Ohio’s has spent $4.7 billion more than anticipated on Medicaid expansion. Cost overruns will top $8 billion by the end of 2017.
Because enrollment in expansion programs shatters projections, cost overruns are the norm. Alaska spent $61 million more than anticipated in the first year. Illinois’ expansion cost $2 billion more than expected. In North Dakota, the state spent $67 million more than budgeted.
Rural Hospitals
More than 150 entities and individuals offered testimony to the committee in favor of expansion. One common refrain: Medicaid expansion will save struggling rural Kansas hospitals.
“It does little to help our Critical Access Hospitals, sending more than 70 percent of new spending to urban hospitals,” Brownback said.
The 84 rural hospitals in Kansas would receive about $19 million of the projected $250 million. The largest chunk of increased funding–$63 million– will go to two hospitals in populated areas.
Timing
Federal assistance for state Medicaid programs may be one of the first Affordable Care Act provisions scrapped by the Trump administration.
“President Trump was elected having declared his intention to do away with ObamaCare, and he has already taken action to alleviate its onerous regulatory and financial burden,” Brownback said.
Federal timing isn’t the only concern. Rep. Greg Lakin voted for expanding Medicaid, but he issued a warning, too.
“The timing is not right for this,” Lakin said.
He suggested lawmakers postpone expansion until after the Supreme Court issues a school finance ruling that could add between $500 and $960 million in expenses to the state’s budget.
Moral Concerns
Some House members expressed concern that the expansion would direct more money to the state’s largest abortion provider, Planned Parenthood, but an amendment to disallow sending expansion funds to Planned Parenthood failed, 72-49.
Pro-life issues aren’t the only moral concern of the bill’s opponents. In other states, data suggests Medicaid finances the nation’s opoid addiction epidemic. It prioritizes able-bodied adults over the disabled, children, and the elderly.
Today, KanCare covers pregnant women, children, people with disabilities, frail elderly, and people with a variety of illnesses including breast and cervical cancer and HIV and AIDS. There are more than 5,000 such Kansans on a waiting list to receive KanCare benefits. The current legislation doesn’t eliminate the back log. It simply adds 150,000 able-bodied people to the Medicaid rolls, making eligible adults without dependents who work less than 32 hours a week. Those beneficiaries receive preference over Kansans with intellectual, developmental and physical disabilities.
“(Expansion) moves able-bodied adults to the front of the line, ahead of truly vulnerable Kansans,” Brownback said in a statement.
Efficiency
Tanner said the added expense might be justified if it delivered quality care.
“However, studies have consistently found that people enrolled in Medicaid receive lower quality care, and have worse health outcomes,” he said.
Medicaid patients are more likely to die from surgery than people have private insurance and than those who don’t have insurance, according to a University of Virginia study.
“In almost every health outcome, Medicaid is outperformed by private health insurance,” Tanner said.
An Oregon Health Insurance Exchange study determined medical spending increased with Medicaid access, but health outcomes did not improve. In return for higher costs, longer waiting lists, and flat health outcomes, the Medicaid program itself faces an uncertain future.
“”Kansas should not tie itself to this failed program of the past just before its inevitable demise. The rest of the nation is moving towards a new state-driven model for improved health outcomes at a price Americans can afford,” Brownback said. “Kansas is well positioned to help lead the way.”