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GOP leaders ‘demonize the poor’ in Medicaid expansion debate while working Kansans struggle

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GOP leaders ‘demonize the poor’ in Medicaid expansion debate while working Kansans struggle

Dec 11, 2023 | 4:50 am ET
By Sherman Smith
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GOP leaders ‘demonize the poor’ in Medicaid expansion debate while working Kansans struggle
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Marcillene Dover was a Wichita State University student without health insurance when diagnosed with multiple sclerosis in 2014. Today, she is a science teacher at Wichita North High School. (Jeff Tuttle for Kansas Reflector)

About this series

This story is part of a series examining the impact of the state’s failure to expand Medicaid.

Monday: The uninsured

Tuesday: Struggling hospitals

Wednesday: Impact on jails

Thursday: Church bells toll

TOPEKA — Marcillene Dover’s diagnosis of a chronic illness propelled her into advocacy for Medicaid expansion — and made her a target for a top GOP lawmaker.

Dover was an uninsured Wichita State University student in 2014 when she learned she suffers from multiple sclerosis, a disease that attacks the nervous system. She couldn’t afford to purchase comprehensive health insurance with the minimum wage she earned from part-time jobs she worked while attending school. Without immediate help, her condition could worsen, and there would be no recovery. She could lose cognitive function or go blind.

“It’s not necessarily a death sentence, but there’s no cure for MS,” Dover said. “There’s no way to regain function you’ve lost. You know your life is going to be different from that point out.”

Shortly after her diagnosis, Dover testified before the Legislature in support of Medicaid expansion, an option given to states under the federal Affordable Care Act to provide health care access to more residents who have low incomes. Years later, Rep. Dan Hawkins, a Wichita Republican, would imagine an alternate reality for Dover in an attempt to discredit her.

Hawkins, now the House speaker, and other GOP leaders in the Legislature have stonewalled Medicaid expansion for years, falsifying the cost of the program while denigrating the sick and vulnerable.

“They can spout off all their political talking points that demonize the poor, and if they mark it as being ‘left-wing’ or ‘liberal’ or ‘handouts’ and stuff like that, then they’re going to have people believing them,” Dover said. “They’re taking advantage of people who are not willing to do the research themselves, not willing to look into any of the actual facts about it. And you know, taking advantage of people who are either uneducated or don’t have access to the facts is kind of low, you know? It doesn’t make sense to me that they can live their life and not feel terrible.”

Kansas Reflector talked to residents across the state and reviewed testimonials gathered by advocacy groups to better understand who would benefit from Medicaid expansion. Most are workers with low incomes who suffer from chronic illness. They are small business owners and their employees, as well as students, cancer patients and those who need mental health treatment.

If Kansas were to join the 40 states that already expanded Medicaid, nearly 150,000 adults and children would gain medical coverage and the state would unlock $682.4 million in annual federal funding. Instead, the $7 billion Kansans have contributed in federal tax dollars to support the national program have been spent in other states.

Gov. Laura Kelly talks to a crowd gathered March 15, 2023, at the Kansas Statehouse to rally in support of Medicaid expansion. She plans to introduce new legislation ahead of the upcoming session.
Gov. Laura Kelly talks to a crowd gathered March 15, 2023, at the Kansas Statehouse to rally in support of Medicaid expansion. She plans to introduce new legislation ahead of the upcoming session. (Sherman Smith/Kansas Reflector)

Democratic Gov. Laura Kelly, a longtime proponent of Medicaid expansion, plans to reveal new legislation ahead of the upcoming session. The plan is to leverage public support during an election year to persuade Republican lawmakers to defy leadership.

As Kelly toured the state this fall to promote Medicaid expansion, Hawkins and Senate President Ty Masterson issued a statement condemning her “welfare express tour.” Their statement was laced with familiar inaccurate claims — that Medicaid expansion would create unsustainable costs for the state while extending services to “able-bodied adults” who “choose not to work.” In reality, three-fourths of the state’s uninsured adults are already working. The cost to the state would be $73.8 million annually over the next decade, but the economic impact could offset that cost entirely.

In an interview for the Kansas Reflector Podcast, Kelly said the arguments against Medicaid expansion can be debunked by looking at the implementation of the program in other states.

“There’s not one of those 40 states that would go back and eliminate Medicaid expansion, because it has not been the hit on the budget that everybody claimed it would be,” Kelly said. “We know that it is not a service just for able-bodied people who don’t want to work. We know that most of the people out there who are eligible for Medicaid expansion are working — oftentimes two jobs.”

 

Expansion facts

For April Holman, the fight for Medicaid expansion is personal.

Holman survived breast cancer in 2012 because she had health insurance. Those who can’t afford regular screenings are far more likely to die from cancer. By the time they catch it, it’s too late.

As the executive director of the Alliance for a Healthy Kansas, Holman helps organize support for Medicaid expansion and fights the disinformation that flows from opposition.

“People are so wrapped up in the political aspects of this issue that they have lost sight of what it’s really about, and who we’re talking about helping, which is primarily people who are low-wage and ill in our state,” Holman said. “But it’s also the providers who care for them, the economy overall, local governments who are spending more to house people with behavioral issues in jails than they would need to if we had expansion.”

April Holman, executive director of the Alliance for a Healthy Kansas, says the politics of Medicaid expansion obscures the need to serve sick and vulnerable Kansans.
April Holman, executive director of the Alliance for a Healthy Kansas, says the politics of Medicaid expansion obscure the need to serve sick and vulnerable Kansans. (Thad Allton for Kansas Reflector)

The state-run version of Medicaid, called KanCare, is available to children, their parents, pregnant women, seniors and people with disabilities. Only those who earn less than 38% of the federal poverty level are eligible. For a family of four, the annual income limit is $11,400.

Under the Affordable Care Act, also known as Obamacare, the federal government offers to cover 90% of the cost of Medicaid services in exchange for expanding eligibility to 138% of the federal poverty rate. The annual income threshold for a family of four would be $41,400.

The Kansas Health Institute, a nonpartisan nonprofit, estimates about 109,000 adults would sign up for the program if eligibility were expanded. The eligibility for children wouldn’t change, but the assumption is that 39,000 more children would enroll as a result of outreach efforts or as their parents enroll. In total, Medicaid expansion would benefit an estimated 148,000 residents.

KHI, which plans to release a new analysis in January, previously estimated the net cost to Kansas would be $738 million over 10 years. That doesn’t account for the economic impact of a healthier workforce and the influx of federal funding. An analysis by Kansas State University researcher John Leatherman in 2019 concluded that Medicaid expansion would increase state tax revenues enough to fully offset the cost. Earlier this year, the state budget director calculated savings to the state of $71.5 million in the first 12 months under proposed legislation that included a new fee to generate revenue.

The Legislature passed a Medicaid expansion plan in 2017, but Republican Gov. Sam Brownback vetoed the bill. In 2019, a bipartisan coalition in the House passed a Medicaid expansion plan through legislative hijinks, but Senate leadership refused to consider it. Another plan appeared to have momentum in 2020 before the Catholic Church in Kansas entered the political fray, demanding passage of a constitutional amendment to ban abortion before expanding Medicaid.

For the past three years, Republican leaders have refused to allow a hearing or a vote on the topic.

Hawkins, whose spokeswoman did not respond to emails seeking an interview for this story, routinely exaggerates the cost of Medicaid expansion. He has compared Medicaid expansion to a lemon on a car lot, and in October he used social media to distribute a meme depicting Medicaid expansion as a Halloween monster.

"I look forward to the governor’s announcement that Medicaid expansion will bring world peace, will prevent slow drivers in the left lane, and will finally reveal whether the chicken or the egg came first," Hawkins wrote in an Oct. 31 social media post. "What the governor won’t tell you is that Medicaid expansion truly is taxpayer-funded health coverage for able-bodied adults who choose not to work."

KHI has found that 75.5% of uninsured adults in Kansas are working, and only 54.1% of Kansans get health insurance through their employer.

An estimated 465 Kansans in Hawkins’ district are working but do not have health insurance, based on U.S. Census data.

 

Tayla Naden, who worked for years without health insurance, now works for the Kansas chapter of the National Alliance on Mental Illness from her Lindsborg home.
Tayla Naden, who worked for years without health insurance, now works for the Kansas chapter of the National Alliance on Mental Illness from her Lindsborg home. (Taton Tubbs for Kansas Reflector)

Untreated illness

When Tayla Naden can find a job that offers health insurance, she can get the therapy and medication she needs to keep her mental illness in check.

Other times, the Lindsborg resident finds herself in a cruel cycle: Her untreated mental illness prevents her from getting a job that would allow her to treat it.

"I have always dealt with mental illness, depression, anxiety since I can remember," Naden said. "I was in several programs for youths growing up. And I mean, it was persistent. It's something that's always been there. And once I hit 18, I lost all of those programs, basically. So I was untreated for a very long time."

If Medicaid were expanded in Kansas, she could have gotten the care she needed.

Naden said she was self-employed for about a decade, running a coffee shop, making jewelry and teaching art classes. She estimates she was working 40-60 hours a week, and "it was a constant battle of trying to survive." She said the most she ever made in take-home pay was between $15,000 and $20,000.

Tayla Naden said she worked 40-60 hours a week while self-employed, but didn't earn more than $20,000 per year. She is frustrated by comments from GOP leaders about those who would benefit from Medicaid expansion being "able-bodied adults" who "choose not to work."
Tayla Naden says she worked 40-60 hours a week while self-employed, including as an art teacher, but she didn't earn more than $20,000 per year. She is frustrated by comments from GOP leaders about those who would benefit from Medicaid expansion being "able-bodied adults" who "choose not to work." (Taton Tubbs for Kansas Reflector)

"There's been several times where I haven't been able to afford my medication, so I'd have to go without it, which of course keeps me from improving, and it stops the progress," she said. "And I would have to start all over again every time I'd get lucky enough to find a job that offers insurance."

At one point, she married her boyfriend in part so she could be added to his health insurance plan.

"The benefits of marriage, as far as taxes and insurance and that kind of thing, was definitely part of the equation," Naden said. "I'm a very practical thinker, and when we had been together for so long, it just seemed like the next natural step to make our lives better."

The marriage, she said, "did not work out well."

A mother of a 2-year-old, she now has health insurance through her work with the Kansas chapter of the National Alliance on Mental Illness. The job allows her to work at home, where she can ride the waves of her own mental health while helping others.

She bristled at the way GOP leaders talk about the people who would benefit from Medicaid expansion.

“It's frustrating because I'm obviously an able-bodied adult, and I do work, but I have my unique challenges that I haven't been able to overcome,” Naden said. “And it's frustrating for somebody to make it sound like I'm not trying hard enough."

 

Marcillene Dover now has health insurance as a teacher at Wichita North High School, but she says she also has nearly $10,000 in medical debt.
Marcillene Dover now has health insurance as a teacher at Wichita North High School, but she says she also has nearly $10,000 in medical debt. (Jeff Tuttle for Kansas Reflector)

Bitter politics

Marcillene Dover felt numbness in her legs as a freshman at Wichita State University, but she didn't know it was because of multiple sclerosis until her junior year.

At first, the "random doctor" Dover could afford to see at a clinic thought she had a pinched nerve. Without insurance, she had to save her minimum wage earnings until she could afford to see a neurologist. It took more than a year to get a proper diagnosis, in October 2014.

Dover was fortunate to receive volunteer medical care through a Sedgwick County nonprofit. She is now a science teacher at Wichita North High School, and while she has health insurance, she also has almost $10,000 in medical debt.

Marcillene Dover was shocked when Rep. Dan Hawkins, now the House speaker, attacked her in a 2018 interview: "He's just picking on someone who gets diagnosed with a chronic illness early in college," she says.
Marcillene Dover was shocked when Rep. Dan Hawkins, now the House speaker, attacked her in a 2018 interview. "He's just picking on someone who gets diagnosed with a chronic illness early in college," she says. (Jeff Tuttle for Kansas Reflector)

She said she had no contact with Hawkins between her appearance before his committee in 2015 and his appearance on a Topeka Capital-Journal podcast in 2018. In the podcast interview, Hawkins singled out Dover for ridicule. He said “she could have easily received care through WSU’s health plan” — even though the plan wouldn't have covered much of the treatment Dover needed — and he chastised her for having “an expensive cellphone.”

"I wasn't afraid to talk about stuff, and it really gave me a sort of power over my diagnosis," Dover said. "It felt like I was doing something about it. It was helpful for me. But, you know, running into people like Dan Hawkins, who's going to call me out for having a smartphone? I just couldn't believe that. He didn't even know I got my phone at Walmart for 50 bucks."

"He thought he was being clever," she added. "I was kind of shocked by the politics and this guy who's supposed to be the pillar of the community, or at least a good role model, and he's just picking on someone who gets diagnosed with a chronic illness early in college, and he doesn't have the decency to say something to my face about it. I thought that was wild."

Around the same time Dover learned she had MS, her mother was diagnosed with colon cancer. She wouldn’t go to a doctor, despite her symptoms, because she didn't have health insurance. She waited until she turned 65 and qualified for Medicare, the federal health insurance program for seniors. By then, the cancer was stage four.

Dover remains bitter about Hawkins and the politics surrounding Medicaid expansion.

"He doesn't care about the people who vote for him," Dover said. "All he does is demagogue around and try to make people who are uneducated feel warm and fuzzy so they'll go vote for him, and he's just getting reelected because no one's willing to check anything other than R next to their name."

 

House Speaker Dan Hawkins, seen during a March 21, 2023, session of the House, exaggerates the cost of Medicaid expansion, mocks the benefit of providing medical care to nearly 150,000 adults and children, and claims the people who would benefit "choose not to work."
House Speaker Dan Hawkins, seen during a March 21, 2023, session of the House, exaggerates the cost of Medicaid expansion, mocks the benefit of providing medical care to nearly 150,000 adults and children, and claims the people who would benefit "choose not to work." (Sherman Smith/Kansas Reflector)

Just winging it

Tammy Shockley moved in July from Kansas City, Missouri, to Shawnee Mission, Kansas, to escape a bad neighborhood.

She didn't realize she would be leaving her health insurance behind. That's because Missouri, unlike Kansas, has expanded Medicaid. Otherwise, she said, she would have "thought twice" about moving.

Tammy Shockley didn't think it would be a big deal to move across state lines, but then she lost access to medical care because Kansas hasn't expanded Medicaid to workers like her.
Tammy Shockley didn't think it would be a big deal to move across state lines, but then she lost access to medical care because Kansas hasn't expanded Medicaid to workers like her. (Submitted by Aryian Shockley to Kansas Reflector)

Shockley works in a warehouse and is the legal guardian for her 13-year-old granddaughter. Before she moved, she had been on Medicaid for five years. She has a fracture in her knee and needs surgery, but she couldn't afford to miss work — and after moving, she didn’t have insurance to help pay for it. It wasn’t until early December that she learned she could get some medical care through a program at a local clinic.

"I didn't think it would be that big of a deal to move," Shockley said. "I guess I found out."

Instead of seeing a therapist for her depression, "I'm just kind of winging it," she said.

Kansas, like the other holdout states, has a higher uninsured rate than the national average. As of 2022, 8.6% of Kansans did not have insurance, compared with the national average of 8%.

Mary Stapleton, of Prairie Village, stopped working because she didn’t have health insurance and fell in the “coverage gap” — she didn’t qualify for Medicaid in Kansas but didn’t earn enough to purchase coverage through the ACA marketplace.

She was 57 years old when she started having back problems — a ruptured disc in her lumbar, a bulging disc in her sacral area. At the time, she was working factory and landscaping jobs. The pain grew progressively worse until she couldn't work anymore.

If Medicaid had been expanded, she said, she would still be working.

"I'd still be in the workforce, paying taxes, spending extra money," Stapleton said. "But I'd be volunteering as well. I used to do the food kitchens and work with Harvester's, take people to their doctor's appointments and that kind of thing. And do grocery shopping and pack boxes for the troops. I'm no longer able to do any of that. If they would have caught this early enough, I wouldn't be in this spot my spine has gotten in today."

She turned 65 in September and qualified for Medicare. She is going to physical therapy twice a week, which has been "a game-changer." She already feels better than she has in two years.

Stapleton said it bothers her when lawmakers describe people like her as lazy.

"They don't know people that are in the Medicaid coverage gap, evidently, or they just don't care and it's all political game," Stapleton said.

 

April Holman, executive director of the Alliance for a Healthy Kansas, speaks during a March 15, 2023, rally for Medicaid expansion at the Statehouse in Topeka.
April Holman, executive director of the Alliance for a Healthy Kansas, speaks during a March 15, 2023, rally for Medicaid expansion at the Statehouse in Topeka. (Sherman Smith/Kansas Reflector)

Political stakes

The Alliance for a Healthy Kansas, the American Cancer Society and other organizations have chronicled dozens of Kansans who fall into the coverage gap.

There are small-town restaurant owners, lupus patients, people with autoimmune disorders, people with tens of thousands of dollars in medical debt, cancer survivors and the children of those who didn't survive.

Holman, the alliance director, said it is "unconscionable" that lawmakers have allowed so many people to suffer. But, she said, she is determined not to be brushed aside.

"Policymakers need to really justify why Kansas is the place that is not going to do this when all of our neighbors have," Holman said. "When families are finding that their family members in Missouri or in Oklahoma or in Nebraska or Colorado have access to care when they don't, living just on the other side of the state border, I think there are a lot of reasons why this is becoming much more noticeable now than it ever has been that we are falling short in Kansas."

The governor says she thinks the Legislature will expand Medicaid in the 2024 session.

If not, Kelly said, it will be the No. 1 issue in the November elections, when all 165 members of the Legislature are on the ballot. Her statewide tour this fall is part of the strategy to apply political pressure.

"It's not something I wanted to do," Kelly said. "I avoided going this route for a very long time. But, you know, if the Legislature won't listen to me, perhaps they'll listen to their constituents."

This story is part of “The Holdouts,” a reporting collaborative focused on the 10 states that have yet to expand Medicaid, which the Affordable Care Act authorized in 2010. The collaborative is a project of Public Health Watch.