Topeka ? The availability of taxpayer-funded health insurance is going to increase dramatically over the next few years, and states need to take the lead in controlling costs, officials said Monday.

“We see this train wreck coming, and we have to take steps to prevent that,” said Andrew Allison, executive director of the Kansas Health Policy Authority.

“The cost-containment imperative is really in our face,” said Deborah Bachrach, former director of New York’s Medicaid plan and now president of Bachrach Health Strategies, a consulting firm.

Their comments came during a forum examining costs of Medicaid, a federal- and state-funded program that serves more than 300,000 low-income families and Kansans with disabilities at an annual cost of $2.5 billion.

Bachrach said federal health insurance reform will provide coverage to 32 million more people nationwide by 2014, and half will be added to Medicaid. In Kansas, that means about 100,000 additional people enrolled in Medicaid, Allison said.

By 2020, Medicaid will be the largest payer of health care, covering one-quarter of the U.S. population, Bachrach said.

Federal rules and political realities prevent cutting eligibility for Medicaid, the services provided and the payments to doctors and other providers.

That means any savings would come from managing patient care more efficiently, Bachrach said.

She said states are going to have to require more efficient health care delivery systems, such as identifying hospital readmissions that are preventable.

And she said a recent decision by Gov. Mark Parkinson and leaders in other states to cut Medicaid payments as a way to handle current budget problems was short-sighted. Parkinson ordered a 10 percent cut.

“It impedes access and it does zip,” for improving quality of care, Bachrach said. She said some states have challenged the legality of Medicaid cuts because under federal law Medicaid payments must be sufficient enough so that services are available to Medicaid enrollees to at least the same extent as they are available to the general population in the area.