When it comes to the Affordable Care Act, Kansas has maintained a stance of reluctance. The Sunflower State is among those that have not expanded Medicaid under the Affordable Care Act. In April 2016, Kansas passed HB2454, legislation that allows health insurers to offer EPO plans with narrow networks and “gatekeeper” requirements similar to HMOs.
During 2017 open enrollment, Kansas consumers who buy their own health plans through the state’s federally facilitated exchange saw larger percentage rate increases than the national average, with Blue Cross Blue Shield of Kansas Solutions raising averge rates by 47.41 percent, and Blue Cross Blue Shield of Kansas City raising average rates by 28.1 percent. But 84 percent of enrollees in the Kansas exchange are receiving premium subsidies, which offset all or most of the rate increase. most enrollees. Medica also joined the Kansas exchange for 2017, providing yet another carrier option in some counties. They capped their total enrollment at 10,000 people, however, which was a loss-limiting tactic they used in
Medica also joined the Kansas exchange for 2017, providing yet another carrier option in some counties. They capped their total enrollment at 10,000 people, however, which was a loss-limiting tactic they used in Minnesota as well. Medica hit their enrollment cap in Kansas during open enrollment, prior to the end of 2016.
Medica and BCBSKS have filed plans for 2018 coverage in the exchange, but Blue Cross Blue Shield of Kansas City has “requested flexibility” from the Kansas Insurance Department. They did not file plans by the May 15 deadline, but may still opt to do so. Rates are not due until mid-July in Kansas. Blue Cross Blue Shield of Kansas City only offers coverage in two counties in Kansas — Johnson and Wyandotte.
Kansas health ratings
Kansas ranked 28th in the Commonwealth Fund’s 2015 Scorecard on State Health System Performance, a five-position slide from 2014. They maintained their 28th rank in the 2017 edition of the scorecard. This analysis evaluates more than 40 health indicators and gives each state and the District of Columbia a composite score.
Kansas fared best when it came to the Access and Prevention & Treatment categories, with mid-ranking uninsured rates (27th for adults and 26th for children), a high percentage of adults without a dental visit in the past year, and a high percentage of children receiving vaccines and mental healthcare. See Kansas’ scorecard for a more detailed explanation of its performance on the individual measures.
America’s Health Rankings gives Kansas a slightly higher ranking of 26th in its 2015 evaluation. Its positive marks included a relatively low percentage of people without access to health insurance through the private marketplace, an employer or the government. Low-ranking measures included primary care physicians and public health funding.
The 2015 edition of Trust for America’s Health scores a range of individual public indicators but doesn’t include an overall health score. See Key Health Data About Kansas.
If a statewide look is too broad, get county-by-county health rankings for Kansas from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.
Is Obamacare helping in Kansas?
The Kaiser Family Foundation estimates that Kansas had 369,000 uninsured residents at the start of 2014.
According to US Census data, the uninsured rate in Kansas dropped from 12.3 percent in 2013 to 9.1 percent in 2015.
There are 83,014 people in Kansas who are receiving premium subsidies in the exchange in 2017 to offset the cost of coverage in the exchange. 54,075 of them are also receiving cost-sharing subsidies to reduce their out-of-pocket costs.
2017 exchange rates and carriers
Following UnitedHealthcare’s exit from Kansas’ individual market at year-end, the state would have been down to a single exchange carrier for 2017.
However, in May 2016, the Kansas Insurance Department announced that Medica Insurance Company and Coventry (Aetna) had filed proposals to sell plans on and off the Kansas exchange. Then, Aetna in August announced it would not expand to Kansas in 2017.
The following rate increases for Kansas exchange carriers have been approved for 2017:
- Blue Cross Blue Shield of Kansas Solutions: 47.41 percent
- Blue Cross Blue Shield of Kansas City: 28.1 percent
- Medica: new to the exchange for 2017 (enrollment limited to 10,000 members, which Medica reached during open enrollment)
The average benchmark plan (second-lowest-cost silver plan) available to Kansas exchange enrollees was 42 percent more expensive in 2017. However, subsidies are tied to the cost of benchmark plans, and the large majority of Kansas exchange enrollees are receiving premium subsidies, which have increased commensurately for 2017.
Kansas enrollment in qualified health plans
In Kansas, 57,013 of an estimated eligible market of 298,000 people signed up for a qualified health plan through the state’s federal exchange during 2014 open enrollment. That figure equated to 19.1 percent of the eligible market. For comparison, No. 1 Vermont saw 85.2 percent of its eligible residents enroll; the national average was 28.0 percent.
2016 enrollment rates were almost double that of the initial ACA open enrollment period, with 101,555 people enrolled in private health plans through the Kansas exchange. Enrollment fell slightly in 2017, with 98,780 people enrolling in private plans through the exchange.
Kansas and the Affordable Care Act
Kansas is a Republican-controlled state, with voters favoring Donald Trump by a wide margin in the 2016 election. Republicans hold the governor’s office and enjoy legislative majorities at the state and federal level. Unsurprisingly, the Affordable Care Act is not popular with politicians in Kansas.
In 2010, just one legislator among the state’s two senators and four representatives voted in favor of the Affordable Care Act. Kansas currently has only Republicans in both the U.S. House and the U.S. Senate, including Rep. Ron Estes, who won a special election in 2017 to fill Mike Pompeo’s seat, after Pompeo was tapped to head the CIA. The entire congressional delegation from Kansas is opposed to the ACA.
Kansas also joined the 2010 lawsuit challenging the constitutionality of the ACA (the Supreme Court ultimately upheld most of the law, but ruled that states could opt out of Medicaid expansion without losing the rest of their federal funding for Medicaid; Kansas has not expanded Medicaid).
Gov. Sam Brownback is a vocal critic of the ACA. He voted against the measure while serving as one of Kansas’s senators, and he continued his opposition after being elected governor. Brownback considered a state-run marketplace early on, but soon turned against the idea.
In August 2011, Brownback returned a federal loan earmarked for developing a state-run marketplace. Insurance Commissioner Sandy Praeger, also a Republican, argued hard for Kansas to operate its own exchange, but was unable to convince Brownback or state legislators.
Medicaid expansion was one of primary mechanisms in the ACA aimed at reducing the uninsured rate. But Kansas is among the states that have not yet expanded Medicaid under the ACA. The state’s decision against Medicaid expansion leaves 56,000 Kansans in the coverage gap, meaning they neither qualify for Kansas Medicaid nor for tax subsidies to help purchase private coverage through the marketplace.
Kansas has seen a 4 percent increase in average monthly Medicare enrollment from before Obamacare took effect through February 2017. Nationwide, there has been a 30 percent increase, so Kansas is lagging well behind most states.
In Kansas, non-disabled adults without dependent children are not eligible for Medicaid regardless of income level. Adults with dependent children are eligible only if their household income is under 38 percent of the federal poverty level.
Medicaid is called KanCare in Kansas. See the Consumers section of the KanCare website for information on benefits, eligibility, and the application process.
Other ACA reform provisions
The Affordable Care Act established a federal loan program to encourage the creation of called Consumer Operated and Oriented Plans (CO-OPs), which are nonprofit, consumer-run health insurance companies. Through the CO-OP program, 23 CO-OPs were set up as of January 2014, although only five remain operational in 2017. No CO-OP plans were created in Kansas, so the widespread closures have not impacted Kansas.
Does Kansas have a high-risk pool?
Prior to 2014, when the ACA reformed the individual health insurance market, private coverage was medically underwritten in nearly every state, including Kansas. Applicants with pre-existing conditions often found themselves unable to purchase coverage, or only able to get policies that excluded their pre-existing conditions.
The Kansas Health Insurance Association (KHIA) was created in 1993 to provide a coverage option for applicants who were not eligible for plans in the private market because of medical history.
Because of the ACA’s guaranteed-issue provision, medical history is no longer a factor in eligibility for private plans in the individual market. This means that high-risk pools are not necessary the way they were prior to 2014. KHIA ceased operations on January 1, 2014, and was set to fully dissolved by June 30, 2015. The program reported a successful termination following significant communication with members about transitioning to the private market.
Kansas Medicare enrollment
In 2015, Kansas Medicare enrollment totaled 487,086, about 17 percent of the state’s population, which is on par with the percentage of the U.S. population that participates.
Kansans who want some additional benefits can opt for private Medicare Advantage plans instead of Original Medicare (i.e., Medicare Parts A and B). About 13 percent of 2015 recipients had enrolled in Medicare Advantage plans – nationwide, it was 31 percent. Medicare Part D offers beneficiaries stand-alone prescription drug coverage, and 58 percent of Kansas Medicare recipients enrolled in 2015. Nationally, about 45 percent of enrollees have Medicare prescription drug plans.
State-based legislation in Kansas
Here’s what’s happening legislatively in Kansas with healthcare reform at the state level: