Medicaid and moral failure
It's rare that one can: (1) do good, in policy terms; (2) do well, financially; and (3) morally stand on the side of the angels. Gov. Sam Brownback and the Kansas Legislature had just this opportunity earlier this year, and they blew it.
The state could have expanded health care coverage to at least 160,000 poor or near-poor Kansans by accepting the federal offer to expand Medicaid, which is an integral part of health care reform. In short, this would have been a win-win-win for good health care policy, a stronger economy and the straightforward morality of helping the most vulnerable Kansans.
Unlike conservative governors such as Arizona's Jan Brewer and Ohio's John Kasich, Sam Brownback, along with the GOP-controlled Legislature, did not rise to the occasion. Even though the federal government will pay all the costs of expanded Medicaid for the first three years and 90 percent down the line, the Republican governing coalition remained unwilling to believe that government can do any good at all.
Thus, rather than extending health care to all adults with earnings under 138 percent of the federal poverty line (about $15,000), the Kansas Medicaid program will remain among the stingiest in the country, limiting eligibility to adults (parents only) who earn less than 32 percent of the poverty line, an unbelievably low $3,700 a year. The governor and the Legislature turned their backs on a program that would help the very poorest Kansans, at almost no cost to Kansas taxpayers. This is terrible policy decision, and one that leave an estimated 58,000 to 78,000 out in the cold with no coverage at all.
At the same time, rejecting Medicaid meant that hundreds of millions of dollars would not be available to stimulate the Kansas economy, both in urban areas and rural counties, where Medicaid helps shore up hundreds of small hospitals, medical centers, and nursing homes.
More generally, with a stagnant state economy, additional and much-needed health care spending would create jobs and boost overall spending. One reputable study, done for the Kansas Hospital Association, estimated that we could gain 4,000 jobs over the next few years.
So that's a second loss for Kansas -- a less robust economy. The negative health and economic policy implications of refusing Medicaid funds are compounded by the additional, perverse effects of requiring Kansas citizens to pay for the improved health care of citizens around the country, while reaping no gains for themselves.
That's right, our federal tax dollars fly away to pay for Medicaid expansion in California, Pennsylvania, and New York, among other states.
What are we, stupid?
Finally, and most importantly, not accepting Medicaid funding represents a profound moral failure by those responsible for governing. We can count beans and conduct studies until we are blue in the face, but simply put, our governor and Legislature have failed our citizens by turning a blind eye to those most in need.
How are we somehow better off as a state if tens of thousands of our fellow Kansans cannot obtain adequate health care? The state is poorer, its most needy are poorer, and so are we all.
We're poorer because bad health care policies will cost us more in the long run, because our economy will suffer from less activity, and because ideology has trumped sensible policy-making and, above all, compassion.
Burdett Loomis is a professor of political science at the University of Kansas.