Sometimes it’s good to stand on principle, but sometimes, by taking a rigid stand, you’re just cutting off your nose to spite your face.
That’s sort of the choice facing Kansas legislators and the governor when it comes to accepting the expansion of Medicaid in the state as part of the federal Affordable Care Act. Kansas is one of a handful of states that has not agreed to the expansion, which will be fully funded by the federal government for the first three years and 90 percent funded by federal dollars after that. Gov. Sam Brownback has expressed concern about the cost of expanding Medicaid and shares the concern of some state legislators about accepting federal funds that they fear may not be available in the future. They also are adamantly opposed to the Care Act and see refusing the Medicaid funds as one of the few avenues available to them to protest the implementation of that law.
A number of Kansans may agree with that principle, but the practicality of this issue was brought into clearer focus this week in news reports about the release of a couple of studies about the impact of the Medicaid expansion on Kansas. Those studies came from the Kansas Department of Health and Environment and the Kansas Hospital Association. KDHE estimated that the Medicaid expansion would provide coverage for about 226,000 Kansans and would cost the state about $616 million more than without the expansion. The hospital association essentially agreed with that cost figure but went on to look at the impact of an estimated $2.2 billion influx of federal matching funds that would be part of the expansion.
According to the hospital group, the expanded Medicaid program would generate 3,500 to 4,000 new health care jobs and contribute about $112 million in new state tax revenue over the next seven years. It also estimated that the state would save $312.5 million it now spends to cover the cost of care for indigent patients. Balancing the costs against the benefits, the hospital association concluded the state would come out about $82 million ahead over the next seven years.
Other staunch opponents of the Affordable Care Act — notably Florida Gov. Rick Scott and Arizona Gov. Jan Brewer — have reached the conclusion that their states have too much to lose by not accepting the federal Medicaid funding. If Kansas stands on principle and refuses those funds, no one in Kansas will pay less federal tax; that money simply will go to other states while 226,000 Kansans go without health care coverage and continue to place pressure on hospital emergency rooms and indigent care funds.
This may not be an easy choice for Kansas lawmakers, but as they consider the expanded Medicaid program they have to consider how much a decision to stand on principle by rejecting this federal funding could or would cost the state in the long run.