By NEAL ALLEN
Wichita State University
The Senate health care bill will hurt Kansas public schools, public universities, highways, public safety, and everything else citizens want from government. Even if they think that the Better Care Reconciliation Act of 2017 will lead to better health outcomes, Kansas Senators and Representatives should oppose this bill.
After weeks of closed-door drafting of a Senate Republican alternative to the Affordable Care Act (also known as Obamacare), Majority Leader Mitch McConnell released the Better Care Reconciliation Act (BCRA) last Thursday.
This Republican-backed “discussion draft” of a massive overhaul of the nation’s health care system has many goals, but possibly the most important is to lock in a long-term cut in federal money going to states through Medicaid. This cut would likely hurt Kansas less than other states, due to our state’s decision not to expand Medicaid under the Affordable Care Act and the fact that KanCare, the state’s privatized provider of Medicaid benefits, is less generous to beneficiaries than the Medicaid programs of many other states.
But the federal government still sent more than $1.8 billion to Kansas in Medicaid reimbursements for fiscal year 2016, according to the Kaiser Family Foundation. Republican backers of BCRA hope that states, who will receive Medicaid dollars in block grants, will find ways to reduce overall health spending, but citizens from all political perspectives should be skeptical of such optimistic projections. The fallout from Governor Brownback’s income tax cut “experiment” show us why.
The cuts to state income taxes in 2012 were passed with an expectation that public schools would reduce their expenditures to fit lower-than-expected state contributions. But state voters, who backed tax-cutting, spending-reducing conservative Republicans in 2010 and 2012, quickly soured on the experiment and installed a new Moderate Republican/Democratic majority by 2016. It turned out that voters wanted to keep funding schools at previous levels, and their state legislature moved in that direction.
A similar pattern will likely emerge if federal Medicaid allocations to Kansas are cut. Voters will find that they want more health care for the elderly in nursing homes, the disabled, and impoverished children than the state can afford. Instead of wanting less spending on health care, they will want more.
Legislators in Topeka will then face pressure to follow the will of state voters and increase state health care spending. Since we have a balanced budget requirement, this increase will have to be made up by increased taxes, cuts in other parts of the state budget, or (most likely) both. So when Kansas voters in 2028 decide they want to, for example, eliminate the sales tax on food, their representatives will not have the money available. If they want to support more mental health training for elementary teachers, or continued innovation in agricultural processes at Kansas State, they will lack the resources to make that happen.
Senators Pat Roberts and Jerry Moran, and Representatives Lynn Jenkins, Kevin Yoder, Roger Marshall and Ron Estes, can support the Senate Medicaid reductions, and will be following a long-term Republican priority to reduce the size of the program. But if they are counting on the state government of Kansas to permanently reduce health costs, the last three years of education and tax politics in Topeka should give them pause.
Kansans, as demonstrated in both voting and public opinion since 2014, like their government about the same size as it has been the last 50 years. Citizens and elected officials alike should keep this in mind as they consider the consequences of shifting health responsibilities to the states, with reduced resources to meet those responsibilities.
Neal Allen is an associate professor of political science at Wichita State University.