OPINION: Know what’s really sick? Missouri, Kansas being stupid on health care

April 24--It's too bad more people didn't show up at the massive free medical clinic at Kansas City's Bartle Hall on Saturday.

Granted, about 1,500 persons came to see a doctor or dentist. And about as many volunteers sacrificed a Saturday to help out.

But if Kansas Gov. Sam Brownback stopped by, I missed him. I also didn't see Missouri Sen. Rob Schaaf or Kansas Sen. Mary Pilcher Cook, two of the most strident voices against Medicaid expansion in their respective states. In fact, I didn't spot any politicians at all.

If they had made time in their busy schedules, they might have run into Candy Crase of Kansas City, Kan., who has painfully swollen joints because she can't pay for thyroid medications. She left the clinic with refills and something she hadn't expected -- an appointment for a well-woman checkup.

The officeholders could have talked to Michelle Parrish of Kansas City, Kan., who was hurting but relieved after having four teeth pulled. Parrish said she's been in pain ever since she got socked in the mouth with a baseball bat about six years ago.

They could have met a 30-year-old Kansas City man who lost his job at a casino about five months ago and needed an inhaler for his asthma. He's looking for a new job but unable to afford insurance until he lands one. Being without a potentially lifesaving inhaler had been terrifying, he said.

These patients, like most at the clinic, fall into "the gap." They make too much to qualify for Medicaid, meaning monthly incomes of more than $358 for a family of four in Missouri, and $656 in Kansas. But they earn too little to qualify for subsidies in the insurance exchanges created by the Affordable Care Act.

Missouri and Kansas could fix this by raising their Medicaid eligibility limits to 133 percent of the poverty level, with nearly all of the cost of the expansion being borne by the federal government.

But they refuse.

In truth, the hard-luck stories at the safety net clinic wouldn't have moved Brownback or the lawmakers holding back Medicaid expansion.

They've heard it all already, and no one has persuaded them that low-income workers deserve reliable access to affordable health care. In their world, Obamacare is bad and "able-bodied adults" don't deserve subsidized health insurance.

So, OK, enough with the sob stories.

But how about a stone-cold economic argument?

Evidence is rolling in that states such as Arkansas and Kentucky are saving millions of dollars by moving health care costs for prisoners, indigent mentally ill citizens and others over to their expanded Medicaid rolls, with the federal government picking up most of the costs.

Those states are seeing dramatic reductions in their numbers of uninsured citizens and creating thousands of jobs through expanded health care networks.

And guess what? We here in the non-expansion states are paying for the other states' good fortune. The Kansas Hospital Association estimates that by the end of 2015, Kansas will have exported more than $355 million worth of federal reimbursement cuts and fees and taxes related to the Affordable Care Act to Washington, where it will be parceled out to states benefiting from Medicaid expansion.

It only gets worse. The Obama administration notified Kansas this week that a pool of money the state receives to help hospitals treat low-income patients -- about $45 million this year -- will be phased out starting in 2018. That will put additional pressure on hospitals and private insurers.

In Missouri, failure to expand Medicaid will result in health providers shifting an additional $1.1 billion to the private insurance market by 2021, the Missouri Hospital Association has projected. In other words, the General Assembly's stubbornness is taking money out of the pockets of people who purchase insurance.

The free clinic at Bartle Hall was great for patients, but it was intended to make a point. Sadly, that point is willfully lost on key people in high places.

Reach Barbara Shelly at 816-234-4594 or [email protected]. On Twitter @bshelly.

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