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Kansas health insurance

Red-state Kansas enrolls just 19% of QHP-eligible market

The prevalence of various diseases, smoking and obesity rates, how many people have health insurance, and attitudes toward health care reform can all influence your opinion of a state. What do you know about public health trends in Kansas? Do you agree with the decisions by political leaders related to Obamacare?

This summary of selected issues can help you decide.

Kansas health ratings

Kansas ranks 23rd in the Commonwealth Fund’s 2014 Scorecard on State Health System Performance, up two positions from 2009. This annual analysis evaluates more than 40 health indicators and gives each state and the District of Columbia a composite score. See Kansas’s Scorecard for its performance on the individual measures.

America’s Health Rankings gives Kansas a slightly lower ranking of 27th in its 2013 evaluation, which is the most recent available. Public health high points for Kansas include a low rate of drug-related deaths, a high high-school graduation rate, and few poor mental or physical health days per month.

Health challenges for the state include a high obesity rate, low per capita spending on public health, and low immunization rates among children and adolescents.

The 2014 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 state-wide look it 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.

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.

Is the ACA helping in Kansas?

The Kaiser Family Foundation estimates that Kansas has 369,000 uninsured residents. About 30 percent, or 110,700 people, qualify for tax subsidies to help the 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.

Kansas enrollment in QHPs

In Kansas, 57,013 of an estimated eligible market of 298,000 people signed up for a qualified health plan through the marketplace during 2014 open enrollment. That figure equates 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 Medicaid

The state’s decision against Medicaid expansion leaves 126,000 Kansans are in the coverage gap, meaning they neither qualify for Medicaid nor for tax subsidies to help purchase private coverage through the marketplace.

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, 24 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 will fully dissolve by June 30, 2015.  The program reported a successful termination following significant communication with members about transitioning to the private market.

State-based legislation in Kansas

Here’s what’s happening legislatively in Kansas with healthcare reform at the state level: