By: Quinn Ritzdorf, News-Press NOW | November 20, 2022

Hundreds of thousands of Kansas residents are without affordable health insurance, stuck between qualifications for Medicare and Medicaid.

Tammi Johnson Arellano is one of those residents in limbo. She was recently diagnosed with cataracts and the doctor told her she is halfway to being blind.

“I still can’t see anything,” she said. “I can’t see the work. I can’t see the drive. I’m getting to the point where I’m having trouble crossing the street.”

But Johnson Arellano is 60 years old — five years shy of being eligible for Medicare — and she doesn’t qualify for KanCare, Kansas’s version of Medicaid, because cataracts aren’t considered a disability and she doesn’t meet the income requirements.

Johnson Arellano said she can’t wait five years to get surgery, but the insurance she has right now creates some challenges. There aren’t any doctors in Topeka who accept her insurance so to get the surgery she has to travel to Kansas City.

“I could do it here in Topeka if I had Medicare or KanCare,” she said. “I have applied twice for Medicaid expansion and they say it doesn’t qualify for a disability because it can be fixed.”

With the current KanCare qualifications, adults don’t receive coverage unless they have dependents, then it’s based on income and household size. For example, an adult with a dependent child at home can’t earn more than 38% of the federal poverty line — one of the lowest eligibility requirements in the country.

“A household of three, so like a parent and two children, that parent wouldn’t be able to make more than about $8,750 a year before they’re already making too much in Kansas to be able to qualify for KanCare,” said April Holman, the executive director of the Alliance For A Healthy Kansas.

Most of the Kansas population on Medicaid are children and residents with disabilities. This leaves Kansas adults under the age of 65 without an affordable health care option. It’s why Medicaid expansion has become a major talking point in the state.

Kansas is one of 12 states that hasn’t expanded Medicaid since the Affordable Care Act went into effect in 2010. According to Holman, about 150,000 additional Kansans would become eligible for Medicaid if it expanded. This is because the income requirement becomes less strict. According to the Affordable Care Act, the federal government would cover 90% of the expansion if the state makes the income eligibility 138% of the federal poverty line.

“It’ll get them back into the system, leading more fulfilled lives, and frankly, save us a lot more money than what we’re ever going to spend,” said Sean Gatewood, the co-administrator of the KanCare Advocates Network.

Advocates of the expansion said it will lower costs at a time of high inflation, decrease medical debt and help companies compete with surrounding states that have expanded Medicaid.

“All of the states around Kansas have expanded,” Holman said. “So we are kind of the remaining holdout. And workforce is a huge issue, we are starting to hear about health care providers in our border communities in particular, that are losing their qualified personnel.”

But those opposed to Medicaid expansion said it would cut funds from those with disabilities. But Holman disagrees.

“All of the groups that advocate for people with disability support expansion in large part because many people who have a disability don’t have that federal disability determination that is their ticket to getting coverage through KanCare,” Holman said. “So many people who have disabilities would be able to get coverage for the first time if we were able to do our expansion in Kansas.”

Johnson Arellano is a perfect example of this. While some people would consider cataracts a disability, it doesn’t qualify as one with Medicaid.

Another concern is funding the expansion. Although the federal government covers 90%, the state still has to foot 10% of the bill. This created some uneasiness in Missouri after voters approved an expansion in 2020. But the process for Kansas is different.

The state can’t approve expansion through a ballot initiative like Missouri. Instead, it has to go through the traditional legislative route as a bill, moving from the House and Senate then eventually to the Governor’s desk. The process nearly worked in 2017 but then-Governor Sam Brownback vetoed the bill.

“This really is not a Democrat or Republican issue,” Holman said. “But in Kansas, it definitely has become kind of caught up in partisan politics.”

Expansion was brought up a couple of times in the Kansas governor race between incumbent Laura Kelly and Attorney General Derek Schmidt.

In an email, Kelly, who won the governor’s race, said, “On day one of my second term, I’ll send a bill to the Legislature to expand Medicaid. Kansas has left nearly $6 billion on the table and forfeited over 23,000 new jobs because of the failure to expand Medicaid. Medicaid expansion would not only provide health care access to over 150,000 hard-working Kansans, it would also help our rural hospitals, stimulate the economy and help us attract and retain high-quality health care workers.”

Despite the politics, Holman said nearly 80% of Kansans support expansion, including Johnson Arellano.

“I have tried to get them to get me on KanCare,” Johnson Arellano said. “I’m not old enough for Medicare, but the biggest thing is I can’t see now. I actually can’t even drive to work, go to work or do anything.”

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