Editorial: Medicaid equation

Some new studies help clarify the Medicaid expansion choice that faces Kansas.

February 27, 2013


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.


Cindy Yulich 5 years, 3 months ago

Excellent commentary that reflects reality. Kansas needs to figure this out just as Arizona, Florida, and New Jersey have.

sciencegeek 5 years, 3 months ago

The subheading is misleading.; there is no "Medicaid expansion choice" in Kansas. The governor dictates, and the legislature rubber-stamps. Big money interests lie, twist facts, and destroy any who dare disagree.

This isn't their fault, it's ours. If reasonable Republicans would get out and vote, we could take our state back.

buffalo63 5 years, 3 months ago

"would generate 3,500 to 4,000 new health care jobs", Brownback wants to create jobs, but not with Federal money? Aren't jobs, any jobs better, for a no income tax experiment?

jafs 5 years, 3 months ago

To be fair, if they accept the money, they'll be criticized as hypocritical by many on the left.

voevoda 5 years, 3 months ago

And if they don't accept the money, they'll also be criticized as hypocritical by many on the left, because of the repeated statements that they "care about the poor." Of course, the governor and the far right state legislators don't care what people to the left of them think, anyway.

just_another_bozo_on_this_bus 5 years, 3 months ago

I agree-- calling them hypocritical would be entirely fair.

jafs 5 years, 3 months ago

So, in your book, they can't possibly do something right - if they stick to their ideological position, they're wrong, and if they bend, they're also wrong.

Kind of like how Obama can't do anything right for those on the right.

just_another_bozo_on_this_bus 5 years, 3 months ago

I don't think they'll do anything that contradicts their strict adherence to their ideology unless they're dragged kicking and screaming into it. Call that whatever you like.

jafs 5 years, 3 months ago

Fine, so if you drag them into accepting federal funds and programs, will you then turn around and call them hypocrites for not sticking to their principles?

If so, you're doing the same thing those on the right do with Obama - nothing he ever does will be right to them.

voevoda 5 years, 3 months ago

The radical right wing's ideology is internally contradictory, making it quite hard for them to act in a way consistent with all of it. It might be a sad state of affairs, but it's one of their own making.

jafs 5 years, 3 months ago

Could be.

But, it seems to me that those who will criticize them no matter what they do are playing the same game that those who criticize Obama no matter what he does are playing, and it's not an interesting one for me.

bad_dog 5 years, 3 months ago

In my book, they were stupid to adopt the multiple stances re: the ACA they took in the first place. Whether it be insurance exchanges or expanding Medicare, they now have the dilemma of choosing which egg facial they prefer: scrambled rationale or hypocrisy over easy. Either comes with toast & coffee...

jafs 5 years, 3 months ago

I don't recall multiple stances, I recall opposition to the ACA being pretty consistent.

bad_dog 5 years, 3 months ago

Point taken. I was referencing the various idiocies rather than the collective idiocy as a whole. Perhaps I should have stated "multi-faceted" or better yet, "multi-farcical" stance...

Alyosha 5 years, 3 months ago

And you know that "if they accept the money, they'll be criticized as hypocritical by many on the left" exactly how?

Also, can you explain exactly what you mean by "on the left"? (If you can't, why do you use the phrase?)

jafs 5 years, 3 months ago

Because I've seen it on here numerous times.

You know what I mean - bozo is a good example of a rather left-leaning poster.

"I agree - calling them hypocritical would be entirely fair".

Paul R Getto 5 years, 3 months ago

Muscular Sam has already off more than his nose. If he still had one it would be getting longer by the day.

Evan Ridenour 5 years, 3 months ago

This editorial states what I wrote yesterday in the "Republicans push through resolution opposing expansion of Medicaid" article. Obviously, I am in agreement. :)

Comment yesterday: "Just like the 50+ million dollar grant to set-up an exchange... take a stance! It doesn't matter how irrational. It isn't like expanding Medicaid with 90% (100% for the first 3 years and then scaling down to 90%) of the cost paid for by the federal government will help Kansas. It isn't like the money the state of Kansas gives up to take a "stance" against the ACA won't just go to another state.

The federal government will spend that money, but instead of it being spent to the advantage of Kansans, it will be spent to the advantage of everyone OTHER than Kansans. I don't know about anyone else, but I am really ecstatic that when the federal government offers a handout to help our state reduce its massive healthcare costs due to the majority of the population lacking coverage that our fine, upstanding state legislators can take the hard stance that they would rather Kansans not have health coverage, even when the state doesn't have to pay for almost any of it! After all, isn't it more important to thumb our noses at Obama then to provide our poor with health coverage (or to just reduce the expense incurred by the state in providing medical care).

All to take a "stance.""

Carol Bowen 5 years, 3 months ago

Will some pot of money really be distributed among the participating states, or is this an assumption gone viral?

courtsider 5 years, 3 months ago

This seems like the easiest choice of ks lawmakers! Not to mention for those who are now not insured!

Kathe 5 years, 3 months ago

I do not agree with doing the expansion. The federal government does not have any money. We are over 16 TRILLION dollars in debt! This administration averages over 1 TRILLION in deficit spending (spending 1 TRILLION more than revenue taken in) every year! The only way the fed. government could begin to pay 100% (and then 90%)of this coverage at all is to raise taxes and/or print more money! I do not want Kansans to sell their soul to the devil.....we are required by law to have a balanced budget and can not print money so we must do what we can to help those in need within the confines of our state. I say YES to standing on principal and hope my representatives continue to do so also.

Greg Cooper 5 years, 3 months ago

Kathe, you apparently did not read the entire article.

What you are saying mirrors perfectly what the writer stated: standing on principle based solely on the fear of being called "wishy-washy" when, in fact, voting for reasonable compromises will probably do the (R or D) Party more good in the long run, to say nothing of the good of the country.

Several posters have demonstrated that the fear of being seen as less than supportive of one side of the other is of paramount importance, over and above the health of the country. I find this to be a quite extraordinarilly myopic view, especially in view that the various representatives and senators, both state and federal, are entrusted by the voters with the overall welfare of each and every one of us. So, we all quit doing that. Criticize the action, not the person. Praise the outcome, not the effort. Work for outcomes that benefit the state and the nation over the few.

Call it what you like, assign to it whatever "ideology" you prefer, obstructionism, cronyism, and money politics are evil in and of themselves. For those who represent me, I demand that you look at the options that are best for the nation, regardless of the pain I may have to endure. I demand that bedroom morals be legislated by family interactions and religious (or lack therof) concerns, but finally not by the lawmakers. I demand that financial decisions be made with the monetary health and future of the entire nation in mind, and not simply thebetterment of the very few.

Your endearment with "principle" mirrors the takeover of both parties by pugnacious, monied, "connected" career politicians who have overshadowed the others who want our state and nation to be better places to live.

Will we ever have a Utopia? Of course not. Can we have a functiional nation in which each of us has an opportunity to make the best of ourselves? Most definitely we can, but only if we adopt the attitude that every citizen is as important as every other.

Obstructionism, ideology: both terms are hurled by both parties, and, amazingly, the terms are interchangeable in today's topsy-turvy political world. Only when we all throw out the talking points, the ideological stumbling blocks, can we move forward (not to use a Democrat phrase).

Alyosha 5 years, 3 months ago

I don't recall anything about "the devil" in the medicare expansion. Can you kindly refer everyone to the source in the bill that talks about "the devil"?

And, exactly what principle are you standing on?

notajayhawk 5 years, 3 months ago

"Balancing the costs against the benefits, the hospital association concluded the state would come out about $82 million ahead over the next seven years."

Even if that were true, then what? Anyone remember the (valid) objection that was voiced about the expansion of S-CHIP before Obama was elected - that it was funded by revenues that were declining and the CBO long-term projections were that it would not continue to be revenue neutral? This is essentially the same problem. Once the state agrees to the expansion, in a few years they're going to be faced with the choice between additional state revenues being used or cutting off the people that were added.

And let's not forget the reality of what's already happening with other provisions of Obamacare - what the fed promises to pay isn't necessarily what they're going to be ABLE to pay:


JW1943 5 years, 3 months ago

Here's the deal: Obamacare is here to stay! The Supreme Court did not throw it out & say it was illegal -in fact they said IT IS LEGAL!! Then after all of Mr. Romney's songs & dances & rhetoric to save America from the one eyed purple monster, did not work, the country once again said a resounding "yes" to Obamacare last November!, otherwise, the country would have thrown Obama out on his nose & Mr. Romney would be the hero of the day - But, that fairy tale did not happen! Right? So why are you people still living the fairy tale that's already left the station with you stumbling around in circles mumbling to yourselves? Wake up!Obamacare is here to stay! Is it all at getting through any of your warped heads yet?

I think Mr. Simons actually did an eloquent job of of saying to our wonderful,but clueless, leaders in Topeka, that "It's Time To Wake UP & Smell The Coffee boys & girls!" You're 2 bit carnival show is over & people have left the auditorium! Thousands & thousands of your neighbors - most of them being very good people who have had terribly serious health problems - are suffering!! And you are their "Representatives" who apparently are telling them to eat cake! You people are scum! Get off your damn high horse & help those in need! Hmmmm, I think a guy named Jesus said something along those lines - you do go to Church every Sunday along with Brownie right? Maybe it's time for some remedial bible stories, you can start in the children's section & work your way up!

notajayhawk 5 years, 3 months ago

"The Supreme Court did not throw it out & say it was illegal -in fact they said IT IS LEGAL!!"

What a shame you didn't read the whole decision (Madkow must not have included it in the sound bites she spooned up to you that day), or you might have noticed that same Supreme Court, at the same time, ruled the federal government could not force the states to accept the expansion of Medicaid. Deal with it.

"the country once again said a resounding "yes" to Obamacare last November"

Seriously? Re-electing a president is an endorsement of every one of his policies? I guess the country said a resounding "yes" to the expansion of the Homeland Security act, trillion-dollar+ annual deficits, the Afghanistan war (and any other he might choose to participate in like Libya), and kill lists of United States citizens without due process? Wow.

(Actually, JW, at the time of the election, polls favored the repeal of Obamacare by a margin of 6 points.)

Alyosha 5 years, 3 months ago

Romney ran on repealing Obamacare. Obama, obviously, ran on not repealing it.

Obama won.

A reasonable citizen can conclude that the sentiment of voters on the topics discussed ad infinitum during the campaign mirrors the position of the candidates on those topics discussed.

Unfortunately, drone killings and other very serious topics were not discussed.

So, no, the obvious answer to your question "Re-electing a president is an endorsement of every one of his policies?" is "no." Nor did the commenter say anything of the sort.

notajayhawk 5 years, 3 months ago

"Nor did the commenter say anything of the sort."

The commenter clearly stated that "the country once again said a resounding "yes" to Obamacare last November". There was no vote on Obamacare on the ballot, therefore the commenter was clearly saying a vote for Obama was a vote for his policies. As you said yourself:

"A reasonable citizen can conclude that the sentiment of voters on the topics discussed ad infinitum during the campaign mirrors the position of the candidates on those topics discussed."

A reasonably foolish and uninformed citizen, perhaps. The polls at the time showed a clear disapproval of Obamacare in whole or part*, and the level of ignorance of the issues and candidates' positions that has been apparent since the election demonstrates the election results had very little, if anything, to do with Obama's position on Obamacare or on anything else.

Bike_lover 5 years, 3 months ago

Yes, the Federal government has debt.

If the Medicaid expansion is turned down by one state it might have a teeny-tiny amount of less debt. Big deal.

If Kansans are so concerned with the debt then they should turn down: social security benefits, medicare, education assistance, military spending, highway funds, farm subsidies.

To turn down the Medicaid expansion because of the "debt" situation and accept money for any number of other programs, that just happen to benefit those who aren't poor, is a travesty. People who need Medicaid aren't any less deserving than anyone else. I for one am thankful I don't need it but that doesn't mean I might not need it in the future. It's not about the worthiness of some people over others.

msezdsit 5 years, 3 months ago

ideology plus stupidity and you got the kansas governor and legislative majority. They think this is one of the few avenues to protest the law. THE LAW, that is worth repeating.

These ideologues have been trying to run the clock out on this issue all along. Wait for the Supreme Court. Oh, well that didn't work, so wait for the next election, well that didn't work, well keep on waiting on something. Waiting on the clock to run out on them seems to be the only solution to their stupidity. That, at the expense of healthcare for a quarter of a million Kansans and 82 million dollars to the state and loss of 3500 to 4000 jobs. Sam eliminated state income tax on those who could afford to pay in the name of creating jobs when there is no evidence that this will work and plenty that it won't. Double edged sword for Sammy. He loses on both issues. Recall Brownback!!!!!!!!!!!!!!!!!!

notajayhawk 5 years, 3 months ago

"THE LAW, that is worth repeating."

It's THE LAW that marriage is defined as being between one man and one woman.

It's THE LAW that marijuana is a schedule one drug with no accepted medical use.

It's THE LAW in many states that voters need to show a picture ID.

It's THE LAW that corporations are considered legal entities allowed to spend corporate funds for the advancement of a political agenda.

Or, if you want to talk about opinions of the courts as opposed to legislative acts, it's THE LAW that the provisions of Obamacare requiring states to expand Medicaid can not be enforced.

I assume your deep respect and devoted adherence to THE LAW extends to these other issues as well, msezdit?

notajayhawk 5 years, 3 months ago

Which is one of the reasons I separated direct legislative action from court decisions. ;)

msezdsit 5 years, 3 months ago

shiver me timbers. Seems all you can come up with is more of the same ideology that I found at fault with brownback

notajayhawk 5 years, 3 months ago

Nice evasion. You made the point - and emphasized it - that Obamacare shouldn't be resisted because it's "THE LAW". I merely asked if your belief system extended to all laws or just those that fit YOUR political ideology (or whatever Rachel Madkow told you to think today).

BTW, if we're talking about ideologies, I guess we can assume you're a typical "it's free money 'cause it comes from somewhere else" liberal?

Commenting has been disabled for this item.