“Don’t cut off your nose to spite your face!” is a silly adage no one would ever think to intentionally do. But that will happen to us Kansans if our elected officials don’t adopt straight Medicaid expansion.

Straight expansion means increasing the eligibility for Medicaid (health insurance for the poor) to include Kansans who earn up to 138% of the poverty line, compared to the current level where adults are essentially ineligible. For a family of four, that is a gross annual salary of $34,638 — a gross monthly income of less than $3,000. Contrary to some rhetoric out there, these are not wealthy people gaming the system.

National data show most adult Medicaid enrollees work, with 62% of adults enrolled in Medicaid working either full- or part-time. Thirty-seven percent either attend school, are caregivers or are in poor health and can’t work. Only 6% of adults who receive Medicaid do not work for the reason categorized as “other.”

Lawmakers fear they won’t be re-elected if they give poor Kansans health insurance for free because the majority of voters have to pay for health insurance. This instinct is understandable. Many Kansas families make great sacrifices to pay their health insurance premiums and co-pays. Why should others get something for nothing? One reason is to help people who are struggling.

But even removing the philosophical reasons, Medicaid expansion makes sense from a purely financial standpoint: Providing Medicaid for low-income Kansans without charging co-pays, premiums and having work requirements is the least expensive option. It may sound counter-intuitive, but states with co-pays and work requirements spend more money administering these regulations than they would if they just provided the coverage without cost sharing.

This means our tax money will be wasted by lawmakers who want to keep people from receiving health insurance out of spite — not principle or sound economics. This is “cutting off our nose to spite our face.”

The real reason for work requirements and cost sharing on Kansas Medicaid recipients is to make it harder for the poor to get and keep health insurance. Who are the “poor” who would be covered under an expansion? The occupations with the largest number of workers covered are, in order: cashiers, nurses/home health aids, retail salespersons, personal-care aids, auto and truck drivers, cooks and waiters, housekeeper/janitor/cleaning people and customer-service representatives.

These are people we all interact with every day, not an imaginary population of lazy people.

Other things that I have learned after participating in the second meeting of the Governor’s Council on Medicaid Expansion are that in addition to straight Medicaid expansion being the least expensive option for taxpayers, data suggests that premiums and cost sharing were associated with worse health outcomes among the poorest and sickest patients. Care provided without premiums improved hypertension, vision and needed dental care and other serious symptoms among the poorest and sickest patients.

I wonder why lawmakers don’t fear that they won’t be re-elected if they make policies that waste our tax dollars? Do we want our tax money to be spent for no good reason other than to administer punitive policies to the most vulnerable families in Kansas?

Legislators should support straight Medicaid expansion not just because it will help the most people but also because it is the most frugal way to spend our tax dollars. 

Ximena M. Garcia, M.D., is a retired physician who lives in Topeka.