by Will Hoerl

In the October 12, 2023, Johnson County Kansas Board of County Commissioners meeting, Chairman Mike Kelly issued a “proclamation of support” for KanCare Medicaid expansion in Kansas.

Mike Kelly gave a short introduction speech, highlighting the BOCC’s long-time support of KanCare.

He said the Johnson County BOCC has had KanCare on its legislative agenda since 2014, and that the BOCC intends to renew that effort for 2024, citing Kansas as only one state in the nation that “hasn’t taken the opportunity to expand Medicaid.”

He listed several financial advantages he saw for Johnson County if KanCare was expanded.

• JoCo hospitals lose an estimated $35 million dollars annually in uncompensated healthcare costs that would be eligible for reimbursement
• Health insurance would be provided for an estimated 150,000 low-income Kansans
• Coverage provided for 7,000 Johnson County residents
• Medicaid Expansion recovers Federal tax dollars
• More than $7 million of charitable care would be provided annually for Johnson County mental health
• Johnson County Emergency Services would also be eligible for reimbursement
• The program pays for itself

“Therefore the Johnson County Board of Kansas Commissioners does hereby proclaim their support of KanCare expansion in the State of Kansas.”

The meeting had a surprise visitor.

Governor Laura Kelly gave a speech on the importance of Medicaid expansion in Kansas.

She stated that getting Medicare Expansion legislation passed in Kansas was her “number one priority for the next legislative session” and stated she is going on a tour called “Healthy Workers, Healthy Economy.”

Governor Kelly listed what she felt were the advantages of expanding KanCare, some of which were

• Coverage for an estimated 140,000 working Kansans who have no health coverage
• Coverage for an additional 120,000 (non-working & children) Kansans
• Reduce Health care costs in the state for everyone
• Protect Hospitals that are in danger of closing
• Return Taxpayer dollars to the state
• Create thousands of jobs
• Hire and retain healthcare workers to continue the “historic business development and job growth we’ve experienced in recent years”

Governor Kelly said Nationwide, Medicaid covers about 20% of all Americans, with the percentage varying from state to state since each state administers Medicaid differently.

The Kansas Medicaid program (KanCare) covers about 480,000 people who are at or below 138% of the poverty level. Currently, 10 states (including Kansas) do not provide expanded Medicaid, and Kansas has about 260,000 uninsured residents, including about 38,000 children. see Medicaid Expansion Map  

The Governor spoke of what she saw as problems in Kansas that she believes the lack of Medicaid expansion causes (or contributes to) the following

• Without Medicaid expansion, Kansas loses the opportunity to bring Federal tax dollars into Kansas
• She suggested that Kansas healthcare professionals are “leaving in droves” for other states that pay higher salaries with better benefits in our neighboring states that have expanded Medicaid
• Uninsured with substance abuse and/or mental health illnesses frequently show up in emergency rooms or the county jail, which is a high-cost solution that puts the burden on law enforcement and courts  NOTE: Several times Kelly mentioned mental health, the legal system, and the impact expanded Medicaid would have.
• Expanding Medicaid would make Kansas more economically competitive

Gov. Kelly said that she had proposed Medicaid expansion each year with support from both sides of the political aisle, but every year the Kansas Legislature leadership rejects her proposals.   

She said those who oppose Medicaid “keep moving the goalposts”, thus preventing Medicaid expansion.   

Gov. Kelly said that Medicaid expansion “is the most sensible investment we can make in the future of Kansas” because it “would lower costs for everyone in every corner of the state.”

She claimed expansion would “pay for itself” by “saving money on mental health, substance abuse, and foster care” and that not expanding Medicaid is losing the State money.

“With every additional month we do not expand Medicaid, Kansas loses more than $66 million,” she stated. “We need to give Kansas taxpayers access to the healthcare services they deserve and are already paying for.”

Gov Kelly ended her speech by encouraging everyone to “call your legislators, and get involved”. 

Both Chairman Mike Kelly and Governor Laura Kelly, spoke of Medicaid Expansion as an unequivocal “good”, neither expressing concern about potential problems.

Both spoke with confidence that the good things they saw would in fact be realized.   

This was not a public forum, so there was no ‘question & answer’ period.

There were no speakers from the other side of this discussion.

The complete absence of discussion, begs several questions.

• Is Medicaid Expansion really all the Governor and Mike Kelly claim it to be?
• Does ‘lack’ of Medicare Expansion cause the problems the governor speaks of, or are there other factors involved?
• How does expanding Medicaid “fix” the problems stated?
• No details were provided as to exactly ‘how’ expanding Medicaid would “create thousands of jobs”.
• There was no discussion about the philosophical issues surrounding Medicaid.   

For example, a number of people nationwide complained that Medicaid uses their tax dollars to pay for procedures that they do NOT want to pay for. Abortion is the most frequently mentioned, but given current policies, transgender treatments may be added to the list.

There has also been public disagreement about the foundational aspects of Medicaid itself, with claims that it is in effect a “single-payer government health care system”, a concept that was specifically rejected by a majority of Americans during the Affordable Care Act discussions. Additionally, there have been animated discussions recently about providing taxpayer-funded Medicaid to those who immigrate illegally to the United States.

Some aspects of Governor Kelly’s speech seem to stand on their own.

Medicaid expansion would seem to “bring Federal Tax dollars back to Kansas.”

There was, however, no discussion on the side effects of that.

Kansas still has to cover a percentage of Medicaid costs, and unlimited coverage could increase the amount the State must cover. The Federal government can print money, but Kansas cannot.   

With regard to rural and small-town hospital closings that were referenced, it is difficult to see how adding Medicaid-covered patients will fix the problem.

• Rural areas lose hospitals primarily because of the dwindling total population (not enough folks to support a full-staff hospital).
• Rural areas also lose local medical staff (and thus coverage) because a local clinic with 3 doctors and a staff, end up being ‘on call’ nearly all the time.
• Not enough patient base to have sufficient staff to spread the 24/7 coverage.  
• It seems to be a challenge to get modern health professionals interested in moving to rural areas.     

One thing is certain, this issue will be decided in the Kansas Legislature.

Neither Mike Kelly nor Governor Kelly will make that call.

To that end, Governor Kelly’s final request for citizens was to “please call your legislators and ask them to demand that legislative leadership give them a chance to vote for Medicaid expansion. Make it clear that every legislator standing in the way of expansion is going against the wants and the needs of the people they claim to represent.”

She continued, “Instead, they should be like the Johnson County Commissioners and work to get Medicaid expanded so we can achieve a healthier workforce, a healthier economy, and a healthier state.”

It is unclear who gave Chairman Mike Kelly the authority to issue the proclamation on behalf of the commissioners supporting the Medicaid expansion since there was no agenda item on the matter, which means there was no public forum, no discussion, and no vote on the matter.

Commissioner Charlotte O’Hara reached out to the Chairman via email prior to the meeting, upon announcement of the proclamation and the special guest appearance, citing her concerns that there was no statement on the horror of the Hamas attack on Israel, requesting the “grave oversight” be corrected in “showing our sympathy, sorrow, and unified support of Israel. “Also, there has not been a vote of the commission specifically on Medicaid expansion. How can we have a proclamation when no study session, no COW (committee of the whole) and no vote on this important issue?  I ask that this be postponed until it has been publicly presented, vetted and voted on.  I do not support this proclamation.”

However, the meeting and Medicaid proclamation proceeded as Chairman Kelly planned, with the suggested addition of the mention of Israel added to the beginning of the meeting with a quick moment of silence.

No matter where one stands on this issue, it is best solved at the legislative level.

Active participation by citizens is a key step to ensuring that whatever decisions get made, they reflect a majority opinion of the people.