By Sara Millburn

If you hired a construction company to build a new house, how would you feel if the builders decided to “cut costs” by pouring a foundation for only 3 sides of the house? In the long run, would you actually be saving money? What would be the impact on the side of the house without a foundation? You expect the wall to stay up regardless to protect your family from the elements. But will it? If the wall does fail, the costs will be higher than if the work had been done correctly from the start.

Public health — literally the health of our communities — is a house. Our legislators decided it is adequate if our house has a partial foundation of health coverage. If our house is made up of four exterior walls of Kansans with different health coverage, one wall is supported by Medicare. One wall is supported by private insurance obtained from employers or the Affordable Care Act (ACA) exchange. One wall is supported by KanCare as it currently stands. But the last wall is built on dirt instead of a proper concrete foundation.

Who makes up this wall? Everyday, hardworking Kansans; more than two-thirds work or are in working families. Essential workers with jobs that may not offer health insurance or offer insurance they cannot afford; maybe they work several part-time jobs or work for small businesses that are not required to provide insurance. Maybe they make just a little too much to qualify for KanCare but not enough to get the ACA subsidies that help people afford the premiums. People who may have lost their jobs due to the pandemic are also part of this group.

Can the wall hold up for a while? Probably. Just put off going to the doctor. Ignore that lump or pain or nagging cough. Maybe try to get an appointment at a free or sliding-scale clinic. Eventually, though, the wall will buckle. The symptoms will interfere with work- possibly permanently. By the time a person seeks treatment at an emergency room — which is much more expensive than treatment at a doctor’s office and the cost of which is borne by charity care or higher bills for everyone else if the person cannot pay — the disease is more advanced than if the person had been insured. The breast cancer patient needs chemotherapy and radiation now instead of a lumpectomy. The minor injury has advanced into a disabling one. If they can no longer work and end up receiving disability and Social Security payments, our taxes pay more for that than if we would pay for KanCare expansion, particularly since the federal government pays 90% of the Medicaid expansion costs. Just as it costs more to go back and try to insert a foundation and fix a crumbling wall than it would to build it right in the first place, it costs more to let a quarter of Kansans go without health insurance.

Let’s be responsible builders. Expand KanCare.

Sara Millburn is Communications Committee Chair for the Kansas Public Health Association