When it comes to the Affordable Care Act, Kansas has maintained a stance of reluctance. Has this attitude shaped the state’s public health rankings, access to coverage, and Medicaid and Medicare enrollment in recent years?
This summary of selected issues can help you decide.
Kansas health ratings
Kansas ranks 28rd in the Commonwealth Fund’s 2015 Scorecard on State Health System Performance, a five-position slide from 2014. This annual 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. About 30 percent, or 110,700 people, qualified for tax subsidies to help them purchase health insurance through the marketplace.
Kansas was a huge outlier in the July 2014 Gallup findings about uninsured rates before and after the ACA’s individual mandate went into effect. While the national uninsured rate dropped to its lowest point in more than six years, Gallup found that the uninsured rate in Kansas rose 5.1 percentage points to 17.6 percent between 2013 and mid-2014.
The Kansas insurance commissioner, the former head of the Kansas Medicaid program, and the spokesperson for the state’s largest insurer all questioned the accuracy of the findings, citing increases in Medicaid enrollment and private health insurance coverage during the measurement period.
A follow-up poll showed that Kansas was among five states without statistically significant reductions in their respective uninsured rates since 2013. All but South Dakota had neither established a locally managed and promoted exchange nor expanded Medicaid.
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, 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.
While proposed rates remain under review, the following rate increases for Kansas exchange carriers have been requested 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
Rates and plan options will be finalized and made public by November 1, 2016, when open enrollment begins.
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.
Kansas and the Affordable Care Act
Kansas is a Republican-controlled state, with voters favoring Mitt Romney in the 2012 presidential 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 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 joined the lawsuit challenging the constitutionality of the health care reform law.
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.
One of the ACA’s main strategies for reducing the uninsured rate is expanding Medicaid to cover those making up to 138 percent of the federal poverty level. Kansas has not adopted Medicaid expansion.
Kansas is among the states that have not yet expanded Medicaid under the ACA. The state’s decision against Medicaid expansion leaves 49,000 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 an 11 percent increase in average monthly Medicare enrollment from before Obamacare took effect through June 2016.
In Kanas, 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. No CO-OP plans were created in 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:
- Kansas lawmakers introduced HB 2319, a Medicaid expansion bill, during the 2015 session. While it got a hearing before the House of Health and Human Services Committee, it has since stalled.
Other state-level health reform legislation: