Bill Kaplan: Bipartisan Medicaid expansion in Kansas
Kansas Democratic Governor Laura Kelly has reached agreement with state Senate GOP leader Jim Denning to expand Medicaid. Kelly said: “Compromise is hard. It’s messy and it’s slow, but it is so worth it.” Similarly, Denning said: “In the spirit of compromise, we have a really good, complete plan.” Importantly, they have the votes to pass it in the GOP-led legislature. Denning emphasized: “It’s a lot easier to get to no than it is to get to yes, but this is what governing looks like.” A roadmap for Wisconsin.
The Walker steamroller era is over in Wisconsin. Now Wisconsin has shared government, Democratic Governor Tony Evers and a GOP-led legislature. For too long Wisconsin has been divided and polarized. The legacy has been fear and mistrust. It’s long past time for Democratic and Republican leaders alike to turn the page. The campaigns are over. Governing must be the priority. Kansas has shown the way forward.
Kansas will be the 37th state to expand Medicaid, with 90 percent federal funding. And, momentum for Medicaid expansion is building across the nation. GOP-led Missouri and Oklahoma will likely hold referendums in 2020. Missouri hospitals, doctors and business leaders are pushing for passage. And, former Oklahoma GOP House Speaker Kris Steele now supports Medicaid expansion. Why? Former Arizona GOP Governor Jan Brewer has the best answer: “You have to do the math. …It’s not only a mathematical issue (90 percent federal funding), but it’s a moral issue.”
The Kansas Medicaid compromise includes: full Medicaid expansion to 138 percent of the federal poverty level (FPL); reinsurance (lowers the cost of private insurance by using a mix of state and federal funds to help health insurers pay big claims, thereby lowering insurance rates); hospitals will pay for the 10 percent state cost of expansion; work referral program to help Medicaid enrollees get job skills and employment; out-of-pocket costs for Medicaid enrollees and “rural health care innovations: (the) proposal creates an advisory committee … to support rural hospitals in assessing viability and identifying new delivery models, strategic partnerships and implementing financial and delivery reform to improve the health of rural communities.”
Wisconsin has already adopted some of the Kansas compromise components. However, the most glaring omission is federal funding for full Medicaid expansion. Wisconsin partially expanded to 100 percent of FPL, thereby remaining ineligible for federal funding. Instead, scarce state dollars are used and Wisconsin’s federal taxes pay for other states’ expansion. Wisconsin should do full Medicaid expansion and take the federal funding (saves the state $324.5 million and covers 82,000 more Wisconsinites).
I asked Dr. Susan Turney, CEO, Marshfield Clinic Health System, if Medicaid expansion would be a plus for Wisconsin. Turney noted that “Medicaid reimbursement is significantly lower than (Affordable Care Act – ACA private insurance) reimbursement … .” Possible solutions: use Medicaid expansion federal funding to cover Wisconsinites with ACA private insurance (e.g., Arkansas) and make the state reinsurance program more generous.
The bipartisan Kansas Medicaid expansion compromise offers Wisconsin a way forward. It’s past time.
— Kaplan wrote a guest column from Washington, D.C. for the Wisconsin State Journal from 1995 – 2009.