Economics Professors Debate Medicaid Expansion in Special Forum
Dr. David Slusky (left) and Dr. Donna Ginther (podium) participated in an important public forum about Medicaid Expansion in Leavenworth in late September.
Two KU economics professors participated in an important public forum in late September regarding whether Kansas should join other states in expanding Medicaid under the provisions of the Affordable Care Act. Dr. Donna Ginther and Dr. David Slusky appeared as proponents for expansion during a special debate sponsored by the Leavenworth-Lansing Chamber of Commerce, squaring off against opponents Dr. Linda Gorman of the Independence Institute and Kansas State Senator Beverly Gossage.
The Affordable Care Act authorizes states to expand coverage to people with incomes up to 138 percent of the federal poverty level. Although 40 states have chosen to accept the program, with the federal government paying 90 percent, Kansas has thus far declined. Estimates are that about 140,000 additional Kansans would qualify were the state to opt in. Former Governor Sam Brownback vetoed an expansion bill in 2017, while current Governor Laura Kelly has continually encouraged lawmakers to send her a new measure.
Dr. Slusky said that Medicaid expansion was already the most studied health policy (over 600 studies), with expansion and non-expansion states providing a unique opportunity for the analyses. He explained that the vast majority of the studies found positive effects on health insurance coverage, access and utilization of care, and do not find any negative impact on employment. One study on health outcomes suggested that 72 lives per year could have been saved in Kansas had the state expanded the program.
Dr. Ginther presented research indicating that failure to expand Medicaid in Kansas has led to closures of rural health facilities, increased property tax burdens to maintain existing hospitals, and significant price spikes in employer-based premiums.
The two opponents generally argued that the results had been disappointing in Medicaid expansion states relative to the amount of money spent; and that the increased enrolment numbers have been understated. Dr. Gorman said that New York and Colorado were already experiencing stress on their state budgets as a result of Medicaid expansion. She also said that states had thus far been unable to audit expansion in a meaningful way; and that there was a high risk of fraud.
Senator Gossage said that Missouri’s decision to expand came as a result of a ballot initiative approved by voters and not as a result of direct legislative action.
“Kansans are smarter than that,” she said.
Dr. Slusky noted that concerns over the federal government someday reducing its 90 percent subsidy could be addressed if Kansas considered a provision in our implementing legislation automatically withdrawing should that occur.
Dr. Ginther added that the panicked argument from a decade ago that Medicaid expansion “would decimate Medicare has certainly not come to fruition. And we have already left over $6.6 billion of federal money on the table by failing to expand.
“The bottom line is that over 140,000 of your friends who need health insurance can get it and not be turned away from the care that they need,” she said. “This is a life-and-death matter for a great many Kansans.”