Opinion: The elephants in the Medicaid room
“My Republican colleagues will not talk about Medicaid expansion. They just won’t. I don’t understand it.”
So said first-term Rep. Christina Haswood this past week during a discussion of the 2021 legislative session, responding to a question about what had surprised her at the Capitol.
As a student of legislatures, I find this disheartening and a bit surprising. After all, talking is what lawmakers do, much of the time. Moreover, on a major issue like this, one expects spirited debate and engagement. We have had it in the past, but no more. As Haswood reports, there is an almost total unwillingness to even mention the issue.
So, why this reluctance to engage, especially on an issue of immense fiscal and health importance to Kansans? My hunch is that GOP lawmakers have no serious policy response because they have no policy, just a reflexive “no” to expansion, especially when backed by a Democratic governor.
This is truly incredible in that by expanding Medicaid Kansas would:
(1) have brought $4-5 billion into state coffers over the past decade;
(2) provide for a 90% federal-fund contribution of state costs, with total reimbursement over the next two years;
(3) provide 130,000-150,000 Kansans with basic medical coverage;
(4) increase revenues at all Kansas hospitals and especially help those in rural areas, which are mostly represented by Republican legislators;
(5) allow Kansas to recapture hundreds of millions of dollars in federal tax dollars that currently subsidize health care in the 36 states that have implemented expansion. At present, Kansas gets nothing in return for the Medicaid tax dollars we send to Washington and are in turn distributed to those 36 states, including California and New York.
(6) reflect the overwhelming preferences of Kansans, with 70% of residents and more than 60% of Republicans supporting expansion.
Although this seems like a familiar issue, take a few seconds to reread these bullet points. Kansas could gain billions of dollars, provide coverage to many Kansans who lack it, help rural hospitals and stop the outflow of our federal tax dollars while receiving nothing in return.
What, I would ask, is the downside? Honestly, the unwavering resistance is baffling, from almost any perspective. In the end, as with their desire to kill the Affordable Care Act, Republicans have no health policy, just knee-jerk opposition to Democratic proposals, either state or federal.
To be sure, the Legislature did pass a bill that allows insurance companies to sell shoddy, low-coverage plans that provide the illusion, not the reality, of coverage. Gov. Laura Kelly properly vetoed that bill. That’s not health care; that’s a charade.
If Republicans had actual, substantive objections to expansion, their lawmakers could talk about these in concrete terms, beyond their ultimate, petty fear that in the future the state might actually have to pay a little to get a lot.
So mum’s the word, as Republican lawmakers talk about trans women playing sports, restrictions on voting and revoking mask mandates, all the while ignoring the fiscal and health implications of their actions and bypassing the preferences of the very voters they claim to represent.
— Burdett Loomis is an emeritus professor of political science at the University of Kansas.