Kansas House candidates on the issues: Medicaid expansion

Last month, we asked our readers what issues they wanted to hear the candidates running for office address ahead of November’s general election. Based on the input we received, we developed a five-item questionnaire for candidates running for seats in the Kansas House of Representatives.

We’ll be publishing the candidates’ responses to one item per day each day this week. Today we’re publishing the candidates’ responses to item #2:

Would you vote for a bill to expand Medicaid? If not, how do you justify that choice in regard to loss of Federal funds, loss of medical facilities especially in rural areas and increasing numbers of Kansans without health insurance? If yes, how do you respond to critics who say it will cost too much?

Kansas House District 14

Angela Schweller (Democrat)

When I graduated from college, I was weighed down with student debt and low pay. However, when my employer offered a 50% match for my 401k investments up to 3% of my salary, I figured out where I could cut spending to make this happen. This is true for Medicaid Expansion as well. Turning away a 9 to 1 matched investment back into our own state is irresponsible. There are many examples in other states showing that Medicaid expansion has been budget neutral or even net positive. Some will argue that we need to fix the I/DD (Intellectually/Developmentally Disabled) community’s waiting list before helping the working poor who would benefit from expansion. The fact is, those two items are not related in funding, and organizations like Johnson County Development Supports who work with the I/DD community also support Medicaid expansion. Holding some Kansans’ healthcare hostage until a separate part of the system is fixed isn’t productive. It is time we stop playing around and get Medicaid Expansion passed, and let’s work on where the system as a whole can improve.

Charlotte Esau (incumbent Republican)

Medicaid Expansion was forced through the Kansas House in 2019 by gutting a very good nurse practitioner bill that could have brought additional access to affordable quality health care to Kansans. I voted against that move, supported the original nurse practitioner bill, and have many concerns over what expanding Medicaid would do to our state budget. Kansas would have to come up with the 10% match out of funds we don’t have now, meaning something else will have to be cut or taxes will have to be raised. The Kansas Health Institute has shared that expanding Medicaid as the bill was written would spend nearly $300 million annually on people who already have insurance today, while adding just 55,000 adults who don’t currently have coverage and cost up to $720 million annually. Most of those not currently covered could work and qualify for fully subsidized insurance, without high deductibles or co-insurance payments. Meanwhile, those who currently qualify for Medicaid have trouble finding providers who will take them as the reimbursement rate for providers has not increased in years. We would be expanding a taxpayer funded system that isn’t working well now, and even worse, isn’t meeting all the needs of our most vulnerable folks such as those with intellectual/developmental disabilities, who are on waiting lists for services they need, and we are talking about years, seven to ten years, of waiting for services they need and qualify for but are not receiving because of waiting lists. Until we can address those needs, adding additional otherwise healthy, not-pregnant, low-income adults to a program that isn’t working well for all now is simply unacceptable.

Kansas House District 16

Linda Featherston (Democrat)

I would vote to expand Medicaid. The 150,000 working Kansans that don’t have access to affordable and appropriate health care is one of the things that finally pushed me to run for office. Kansas has already lost over $4 billion by not expanding Medicaid. That comes out to sending $1.8 million of our tax dollars to other states every day. We need that money working here in Kansas.

In Johnson County alone, we expect that expanding Medicaid will generate $60,000,000 of heath care spending and 1,500 jobs. We need that money and those jobs to help recover from the pandemic-related economic downturn. Expanding Medicaid would support our essential workers in home health and child care, among other fields, by providing them access to affordable healthcare. These are the types of low wage earners that earn too much to qualify for assistance, yet cannot afford to pay for health insurance. If we have learned nothing from he pandemic, I hope we have at least learned how important our essential workers are, and that we need to do more to support them.

The argument that Medicaid expansion is too costly is a false narrative. When people don’t have access to affordable, appropriate health care, they are forced to seek treatment in the emergency room. This is the most expensive place to receive treatment and that cost is passed on to others when patients cannot afford to pay. If these medical issues were addressed at the appropriate point in the health care system, rather than when they become emergencies, it would help control health care costs for everyone. In addition, in 2015, the Johnson County health department provided roughly $6,000,000 of free mental health care. If we’d had Medicaid expansion, $3,500,000 would have been covered. That’s a savings to taxes payers, not an extra expense.

In short, we need our taxes dollars working here in Kansas, paying for Kansans’ healthcare instead of sending to other states to pay for their healthcare.

Rashard Young (Republican)

Did not respond.

Kansas House District 17

Michael Kerner (Libertarian)

I would, if I had the power, remove all government intervention in the medical system. Since government stuck their nose into medicine, they have made it drastically more expensive and less friendly. I am old enough to remember how things were before Medicare, Medicaid, etc… came upon us and things were much better for everyone.

I understand that, as a practical matter, that is not possible now. When government gets fully entrenched in an industry, it is exceedingly difficult to extract it while being equitable to the participants. I will not, however vote to expand its influence further. I will look for ways to undo some of the damage if it can be done without gross inequity.

This position should be considered in combination with my desire to reduce taxes and get government out of our lives whenever possible,

Kristine Sapp (Republican)

Healthcare reform is imperative but adding thousands of people into a program with so many issues isn’t the answer. We need to fix the current problems with Medicaid before expanding it. We need to ensure those who need it have access specifically children, the idd community and the those with mental health needs. We need balance between high-quality care, quality coverage, and lower out of pocket expenses. Competiteve markets will drive quality up and prices down.

Jo Ella Hoye (Democrat)

Kansans need access to care and protections for pre-existing conditions. We must close the coverage gap and make sure that all Kansans have access to affordable healthcare and prescription drugs. The Kansas Legislature failed to move forward with Medicaid expansion during the 2020 legislative session, so I will be a steadfast advocate for Medicaid expansion when I take office in 2021. We need lawmakers who will make sure that we utilize the services that the Federal Government offers such as the Excellence in Mental Health Centers Act. Kansas currently receives zero dollars, because we chose not to participate. We are missing out on billions of federal dollars for healthcare that should be used right here in Kansas. Medicaid Expansion would boost our economy and create more than 4,000 jobs. Governor Kelly and Senator Denning’s compromise legislation would have given 150,000 Kansans access to health coverage in January 2021. It was a good compromise, and the Kansas Legislature needs to take immediate action to get an expansion bill to Governor Kelly’s desk in January. Maintaining your health, or treating an emergency, should not come with a threat of financial ruin. I will be relentless in the pursuit of your healthcare access.

Kansas House District 18

Cindy Neighbor (incumbent Democrat)

On Medicaid Expansion, I am very much a supporter. We have more than 150,00 individuals who are not covered. With the pandemic here, that number could very well be higher. We have rural hospitals that have closed. People in rural areas are having to drive to other towns to get the hospital services they need. Without local hospitals, many rural areas may not last.

We have also given away more than $4 billion dollars to states that already have Medicaid Expansion. Those are our hard earned dollars that could be spent right here in Kansas. The plan that was a compromise between Governor Kelly and Senator Denning was designed to be revenue neutral. There would be buy-in from recipients with a small copay. If the program was taken away by the federal government, the Kansas plan would also go away. If people truly read the proposal, they would have a much better understanding of the program and its services.

Cathy Gordon (Republican)

Access to healthcare is the problem, in Kansas. According to the Kansas Department of Health & Environment over 90 Kansas counties have some type of healthcare shortages. Expanding Medicaid does not fix the problem of health care shortages and access to health care. Furthermore, there is a shortage of MEDICAID accepting providers (Physicians, nurse practitioners, etc). Did you know that the KS Board of Healing Arts reports that there are 3,860 licensed physicians in Kansas? Sadly only 742 of these physicians accept Medicaid Insurance plans. There is no incentive for providers to accept Medicaid clients except mercy for their clients. In addition, the administrative burden has increased for those who are accepting providers.

Most people don’t realize that Medicaid reimburses at 50% or less than private insurance. Furthermore, you the patient, are often charged at over three times the actual reimbursement for the same billing codes. Most people also don’t realize that if you see a nurse practitioner in a medical office you are billed at the physician fee schedule, yet the nurse practitioner only receives 75% of that fee schedule with Medicaid. Who is pocketing the extra money, even if it is only a fraction of the reimbursement from private insurance?

I accept Medicaid insurance plans and the clients who choose this insurance. I believe in access to healthcare and giving back to my community.

Until we equalize payment for services rendered, equity of fee for service for all providers, while increasing provider who accept Medicaid, and most importantly decrease the provider shortages in Kansas. We cannot add another program that no one can service.

Kansas House District 20

Mari-Lynn Poskin (Democrat)

Expanding Medicaid in Kansas is both a moral and economic imperative. We have sent over $4 billion in Kansas taxpayer money out of state. We could reclaim over $500 million per year for our state economy and create approximately 13,000 jobs. Critics who say it will cost too much are usually considering only the “sticker price,” not the net costs, cost savings or increased revenue from the economic impact of expansion.

Uncovered individuals forego primary care and end up in emergency rooms -the most expensive form of healthcare- driving up costs for everyone with uncompensated care. Medicaid expansion could cover 150,000 Kansans (maybe more due to pandemic job losses) including an estimated 7,400 veterans.

Healthcare is the #2 industry in house District 20 and both our Leawood and Overland Park Chambers of Commerce include Medicaid expansion in their legislative priorities. It is good for our district and for our state. I would absolutely vote YES on Medicaid expansion.

Jane Dirks (Republican)

I believe we must preserve Medicaid for who it was intended, many of whom are currently on waiting lists. That includes the elderly, the disabled, and pregnant women. Expanding the program would not help these individuals – it would actually remove the affordable options that many able-bodied adults currently use for private insurance. It also does not save rural hospitals – that is a misnomer that has long been debunked. The better way would be to turn our attention to shrinking the waiting lists and expanding choices so all Kansans can obtain affordable health coverage.

Kansas House District 21

Jerry Stogsdill (incumbent Democrat)

We should absolutely expand Medicaid. It will facilitate the return of billions of our federal tax dollars which will allow us to provide better healthcare for some of our most vulnerable citizens. It will also help our most vulnerable hospitals to remain open to serve all parts of the state, it will create thousands of new, good paying healthcare related jobs and it will provide a major economic stimulus which will be spread across the entire state. I have voted in favor of Medicaid expansion every time we have had the opportunity but it has failed to pass because of the Trump supporting leadership in the Kansas Senate.

Saying that it will cost too much is simply not true. The bill that we passed in the House, twice, had a caveat that if the federal government’s contributions ever fell below 90% Kansas would withdraw from the program. Right now 38 states, including Missouri, Nebraska, Colorado and Oklahoma, have all passed Medicaid expansion and not a single state has ever chosen to withdraw from the program.

Bob Reese (Republican)

Did not respond.

Kansas House District 23

Susan Ruiz (incumbent Democrat)

Yes, I will continue to advocate and vote on a clean bill to expand Medicaid. The reality is that it is costing the tax payer more to pay for the uninsured. Many of the uninsured use the ER as their primary mode of medical care. Having access to primary healthcare will help to prevent a medical crisis that doesn’t come to the level of emergency care. The other reality is that the 150,000 who would benefit from expansion are hardworking Kansans who often work two or more jobs without benefits, just to pay the rent and put food on their table. We are losing millions of federal dollars waiting for expansion. There are also those to say that we should “fix” the system first before expanding Medicaid. Well, the Centers for Medicare and Medicaid (CMS) has needed updating for decades, so using that as an excuse is wrong. We can’t continue to use the “fix it first” excuse while close to 150,000 lack access to healthcare.

Matthew Clark (Libertarian)

Kansas should not expand Medicaid. Ninety percent of Medicaid expansion is paid for by the federal government which is currently $27,000,000,000,000 in debt. Medicaid expansion does nothing to address the reasons healthcare is so expensive, it merely borrows more money from our future generations to put a bandaid on the problem. Kansas can not “lose” federal funds we never had. For decades, federal and state governments have continued to overregulate and otherwise interfere with the health care and health insurance markets. The burden of this regulatory compliance is so great that only massive corporations have the ability to comply with this insane web of bureaucracy. This severely limits competition, limits new entrants into the market, has led to large scale consolidation in the industry, limits transparency and has led to skyrocketing price increases. The problem with the healthcare industry is too much government meddling. The solution is not more government, but less government.

Jeff Shull (Republican)

Did not respond.

Kansas House District 29

Brett Parker (incumbent Democrat)

I have voted for Medicaid expansion at every opportunity in my four years in the legislature so far. Entirely too many people are living without health insurance, especially now during a global pandemic. We have a responsibility to our constituents to help get affordable access to healthcare. Medicaid expansion in Kansas will also return money to our local economies. It will not cost too much to implement, in fact Kansas has lost over $4 billion by not expanding Medicaid.

Jerry Clinton (Republican)

Did not respond.

Kansas House District 30

Brandon Woodard (incumbent Democrat)

Medicaid expansion is fiscally sound, common sense, and humane policy that is critical to the long-term health of Kansans as we navigate this pandemic and rebuild our Kansas economy. We need a healthy workforce and that starts with quality, affordable healthcare for all Kansans. With the Federal government covering 90% of the cost of expanding Medicaid to cover more than 150,000 Kansans, this is one of the wisest investments Kansas can make. It is well past time to join 39 other states and expand Medicaid, bringing our Federal tax dollars back to Kansas and building healthy communities in every corner of the state.

Laura Williams (Republican)

My priorities are protecting medicaid for those who need it the most. We have significantly long waiting lists and problems with access to critical care among the disabled, chronically ill and children. Improving Medicaid access and coverage for those in the greatest need is a top priority for me.

When I approach this issue I’m going to be looking at it through the lens of making sure it benefits those who are in need and working to find solutions to protect medicaid and make it better for those who face significant health and financial challenges.

Kansas House District 39

Les Lampe (Democrat)

Affordable and easy access to healthcare greatly affects everyone’s quality of life. Studies continue to show that medical debt contributes significantly to financial instability for families. I will fight to ensure that you are able to get the care you need without worrying whether you can afford it.

As the question implies, Medicaid expansion creates benefits in three areas. First, Medicaid expansion would improve the health and financial security for 150,000 Kansans. Secondly, Medicaid expansion protects healthcare coverage in both urban and rural communities. Over 30 hospitals in rural parts of the state are in danger of closing. Medicaid expansion can make the difference between these hospitals staying open or closed. Finally, with Medicaid expansion the state would actually see substantial economic benefits. Over $4 billion has been sent by Kansans to Washington to support Medicaid expansion in other states. Ninety per cent of the costs of expansion are covered by Federal dollars. Medicaid expansion in Kansas would add approximately $650 million annually to the Kansas economy and add more than 13,000 new jobs.

  • Several studies have shown that Medicaid expansion can generate savings and new revenue in excess of costs. Among the sources of savings and revenue are:
  • Federal funding replaces state funding for coverage of low-income Kansans.
  • For many Kansans covered under Medicaid through the current KanCare program, the state pays 45% of the costs. With Medicaid expansion, the state would pay only 10% of the costs.
  • Insurers and medical providers would pay increased assessments to offset the cost to the state.
  • Medicaid expansion creates economic growth and jobs that leads to more revenues to the state.

The continuing failure of Kansas to move forward with Medicaid expansion adversely affects both the health and the economy of the state. We must move forward with Medicaid expansion.

Owen Donohoe (incumbent Republican)

I believe we should fund the most vulnerable first. Currently we have 5,849 on the Intellectual and physical disabilities Medicaid waiting list. This session we secured a relatively small $22 million increase to move people off the waiting list, but the Governor cut it out of the budget. We need to first fully fund those on the waiting lists. If Medicaid were expanded, approximately 135,000 individuals would be added to Medicaid. Of those 135,000 approximately 39,000 are children that are currently eligible for coverage through the S-Chip program. Their parents only need to enroll them in the program. If you assign one parent to each of these children, that’s 39,000 of the remaining 96,000 that very well may not enroll themselves leaving 57,000 individuals that would qualify for Medicaid. Those individuals without pre-existing conditions could be covered under programs similar to the Farm Bureau Plan, which would be advantageous to them because they would have better provider services and not limited by the few doctors that actually accept Medicaid. Those with pre-existing conditions could be put into a high-risk pool at a lower overall cost to the state. The other issue we have to look at with Medicaid expansion is the arbitrary number that the government chooses for qualifying for coverage. If one person qualifies right at the level chosen, but another person is $1,000 over the number chosen there is a clear disparity. One person receives full Medicaid benefits and the other none. So, does the person that makes $1,000 over the limit reduce their income by $1,000 so they can now qualify? You can see where there would be room for manipulation and abuse of the system. This is why we need to find better solutions that helps all hard-working Kansans.

Medicaid should be for the truly most vulnerable – those with intellectual and physical disabilities, pregnant women, children, veterans, and at-risk seniors. We also have a shortage of providers that will accept Medicaid, or if they do accept Medicaid, they limit the number of Medicaid patients in a daily clinic. By adding able-bodied adults to the program those who are disabled and in vulnerable populations have an even harder time being seen by a provider. We crowd out those individuals who are truly in need, and we crowd out private insurance programs within the state reducing options for everyone. I remain committed to funding the most vulnerable first, and believe the 22 million dollars that the Governor cut from the budget should be allocated back to those on the intellectual and physical disability waiting list.

Tomorrow we’ll publish the candidates’ responses to item #3:

Politics seems more polarized than ever, with activists in both parties seeking ideological conformity on many issues. What experience or relationships can you point to that show you have an ability to reach out and work with those who might not always agree with you? Please give specific examples.