The Health Forward Foundation’s 2014 policy agenda has a clear top priority for both Kansas and Missouri: the expansion of Medicaid to cover those who are currently left out of any eligibility systems.
By way of explanation, the Affordable Care Act (aka, Obamacare) originally created a seamless health insurance coverage that would require states to extend their current Medicaid eligibility levels to 138 percent of the federal poverty level for everyone, even childless adults. Folks making more than that threshold would qualify for subsidized coverage through the health insurance marketplace.
In 2012, the U.S. Supreme Court ruled the entirety of the ACA constitutional, except the mandate that states increase their Medicaid eligibility levels. Neither Kansas nor Missouri have expanded their Medicaid eligibility criteria, despite the fact that the vast majority of these costs would be borne by the federal government. The end result is a hodge-podge eligibility system with a gaping hole smack in its middle. This means that there may be Kansas Citians who make too much to qualify for Medicaid and not enough to qualify for subsidized coverage for the marketplace.
To date, 26 other states have opted to expand Medicaid. It is Health Forward’s hope to add Kansas and Missouri to this list.
The 2014 Kansas legislative session promises to be centered around school finance issues with a major subtext around Governor Sam Brownback’s bid for reelection. Movement around Medicaid expansion will certainly be an uphill battle. On the plus-side, Gov. Brownback transitioned the state’s Medicaid program into KanCare, a managed care system, in 2013. He is rather proud of the system that is in place, even if advocates and others continue to question the cost-effectiveness and quality of the revamped program. In addition, Gov. Brownback has not explicitly come out in opposition to an expansion.
The Kansas hospital and consumer advocacy is launching a full-court press on the issue, even bringing former HHS Secretary Mike Leavitt to the state to discuss conservative approaches to the expansion.
Despite these positive signs, Gov. Brownback has exhibited little interest in expanding Medicaid and the majority party in the legislature is taking their cues from him. The calamitous launch of healthcare.gov doesn’t help matters.
While policy wonks and some legislators know that the Medicaid expansion question is wholly separate from the marketplace, the negativity around “Obamacare” is worse and has tainted Medicaid expansion as well. All of this is happening in an election year, which will make members of the legislature and the Governor cautious about taking any position that could hurt them at the polls in November.
The Missouri legislature, with its strict term limits, seems to be one big, long election cycle and 2014 will prove no different. Feb. 25 is a key date: the deadline for candidates to file for General Assembly primary elections. Many incumbents will be watching whether they are facing a primary challenger and who that might be.
While Missouri is fortunate to have the Governor’s leadership around Medicaid expansion, the language has shifted to focus on reform (which just might include expansion). Both then Senate and House hosted interim committees focused on Medicaid, with reform leading the conversation and expansion trailing far behind.
The House seems to be better poised to tackle the issue with Representative Jay Barnes putting a lot of time and thoughtfulness into crafting a reasonable reform proposal. Movement in the Senate seems less likely and much slower.
Still, don’t expect much action on Medicaid until after the candidate filing deadline in late February.