Topeka Young adults, low-income individuals and certain minority groups in Kansas are now more likely than their national counterparts to be without health insurance, the Census Bureau said Thursday.
Those trends are fueling renewed debate in Kansas' upcoming gubernatorial election over whether the state should expand its Medicaid program under the Affordable Care Act, also known as Obamacare.
The new Census report provides a more detailed look at the uninsured population than the general data that was released earlier this week. That report showed that while the number of uninsured people in Kansas has been falling, it has been doing so at a slower pace than the rest of the nation.
"You see over the last 10 years or so that Kansas has had an advantage over the rest of the country in terms of insurance coverage," Robert St. Peter, president and CEO of the Kansas Health Institute, said in a telephone interview.
"In most cases, different groups of Kansans fared better than the rest of the country, and in some cases we were very similar to the rest of the country," he said. "But pretty much across the board, any group you look at, whatever advantage we had over the years has disappeared, and in some cases the trend has actually reversed, where Kansans are now more likely than people in other states to actually lack insurance coverage."
The report was part of the American Community Survey, an annual report that tracks incremental changes year to year in the way Americans live and work.
St. Peter said Kansas' refusal to expand Medicaid under the ACA is the primary reason why the state's uninsured rate hasn't fallen as much as it has in other states. But he said Kansas also has done a generally poor job in getting people enrolled in other health insurance options.
"States that generally have a more favorable (view) of the ACA and that may be more enthusiastic and engaged in supporting it may have had more success than states that have generally been reluctant to engage the ACA," he said.
The report also showed that the rate of uninsured people is not spread evenly, in Kansas or throughout the country.
In Kansas, the 2nd Congressional District, which includes Lawrence, had a measurably lower uninsured rate than the rest of the state.
"That probably reflects the socio-demographic makeup of those districts," St. Peter said. You would expect the districts that have more urban centers to have a higher uninsured rate, for example Wichita and Kansas City."
"I would say that in general, we see that inner-city areas that have large minority populations and low-income populations, maybe immigrant populations, tend to have higher uninsured rates," he added. "Southwest Kansas is unique in the sense that it’s a rural part of the state that has a lot of immigrants, people that are working in industries that may not offer insurance to all their employees, or at least to thee dependents of those employees."
Nationally, the heaviest concentrations of uninsured individuals was in the Deep South.
The issue of Medicaid expansion has divided the seven major Republicans who are vying for the 2018 gubernatorial nomination.
Two of those candidates are practicing physicians who are on opposite sides of the debate: former state Sen. Jim Barnett, who supports Medicaid expansion; and Lt. Gov. Jeff Colyer, who opposes it.
"We have let 150,000 Kansans go without insurance when we could have helped provide coverage," Barnett said. "That is so important for many reasons including the fact that people wait too late in the disease process before they go to the emergency room."
Colyer's spokeswoman issued an email statement saying, "Lt. Governor Colyer is working with Governors, members of Congress, and the Trump Administration in support of their efforts to repeal and replace Obamacare. As Governor, he looks forward to working with everyone to develop Kansas solutions to our health care challenges."
GOP candidate Ed O'Malley, of Wichita, who is currently running an exploratory campaign, also supports Medicaid expansion, with some conditions.
"I'm in favor of bringing Kansas federal tax dollars back to Kansas for Medicaid with three key caveats: 1) this can be done without increasing State General Fund spending, 2) any increase in costs are covered through innovation or partnership with the private sector and 3) if the feds back out so do we," he said in an email statement.
Former Rep. Mark Hutton, R-Wichita, also expressed conditional support for Medicaid expansion.
“For Medicaid expansion, any program would have to include two key conservative components — including work and co-pay requirements from able-bodied adults and a protection for Kansas taxpayers that any drawback of financing from the federal government doesn’t leave Kansas taxpayers in the lurch,” he said in an email statement.
The other three Republicans oppose it.
"Every state that has expanded Medicaid has seen costs significantly exceed estimates," Secretary of State Kris Kobach's campaign spokeswoman said in an email statement. "Bankrupting the state to expand Medicaid will end up hurting the vulnerable most of all. Kris's aim is to make sure Medicaid serves its intended purpose of covering those who truly need it, not able bodied adults."
Insurance Commissioner Ken Selzer did not immediately respond to a request for comment Thursday, but he opposed it during his 2014 campaign.
And Wichita businessman Willis "Wink" Hartman has stated publicly that he doesn't believe Kansas can afford to expand Medicaid.
On the Democratic side, House Minority Leader Jim Ward, of Wichita, and former Rep. Josh Svaty, of Ellsworth, both strongly support it.
"I was the first person to introduce a bill to expand Medicaid four years ago," Ward said in a phone interview. "And I've been pushing. We got hearings, and this year we got a vote. We got 81 people in the Kansas House and 25 people in the Kansas Senate. We just need a different governor who won't obstruct that."
"I would have expanded Medicaid. There are two takeaways there," Svaty said. "One, those are our tax dollars in the first place. And then two, the bulk of that money would have gone to seniors and children."
Former Wichita Mayor Carl Brewer did not respond to a request for comment Thursday.