Expanding Medicaid in Kansas

Expanding Medicaid in Kansas would be costly, undoubtedly more costly than estimated, has an uncertain future, and doesn’t provide very good results for those it covers.

Providing testimony to the Kansas House Committee on Health and Social Services, Michael Tanner advised legislators, “Medicaid expansion, however, is a risky gamble, that is almost certain to cost more than you are currently budgeting, while providing surprisingly little to the poor in terms of improved access to health care.”

Tanner is Senior Fellow at Cato Institute. The bill in question is HB 2064, titled “Establishing the KanCare bridge to a healthy Kansas program.” It would expand Medicaid eligibility to more people in Kansas. These quoted remarks are from Tanner’s written testimony, which may be read at Should Kansas Expand Its Medicaid Coverage.

As to the cost of Medicaid expansion, Tanner wrote: “Second, while such estimates are concerning enough in themselves, and would almost certainly require a substantial tax hike to finance, there is ample reason to believe that they understate the actual cost. For example, actual enrollments following expansion have exceeded estimates in every state that has expanded Medicaid under the ACA, in most cases by double digits and in some cases by more than 100 percent. In neighboring Colorado, the maximum projected enrollment was 187,000 and as of October of last year enrollment had exceeded 446,000. … In addition, the per enrollee cost has risen faster than predicted.”

Then, there’s the woodwork effect, which costs are covered only at the regular Medicaid reimbursement rate, not the 94 percent citizens might be tempted to believe: “Third, while it may be tempting to focus on the 94 percent FMAP [Federal Medical Assistance Percentage] for newly eligible adults, you should keep in mind that many of those who enroll under expansion will not fall into this category. Rather, they will be previously eligible individuals or families that are lured into the system through the publicity and outreach efforts surrounding expansion. The Robert Wood Johnson Foundation and the Urban Institute have dubbed this the ‘woodwork effect.’ Woodwork enrollees are not eligible for the enhanced FMAP. Instead, Kansas will have to pay 43.79 percent. In states that have expanded Medicaid under ACA, as much as half or more of those who signed up have fallen into this woodwork category.”

Tanner also noted the uncertainty over the future of the Affordable Care Act, or Obamacare, under the Trump Administration, warning legislators, “You may well be locking yourselves into future spending based on hopes for federal dollars that may never materialize.”

He also noted the studies that have found that being on Medicaid does not result in very good health outcomes, most notable in the Oregon study.

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