Kansans face health care challenges and federal changes won’t help, experts say

TOPEKA — Costly and unequal access to health care draw down the overall ranking of Kansas’ health system in nationwide evaluations of successes and failures.

Kansas has one of the lowest-performing state health systems in the country, ranking 33rd, according to the Commonwealth Fund’s 2025 Scorecard on State Health System Performance, which was released Wednesday.

However, two key metrics — uninsured rates and the number of adults forgoing medical care because of cost — have both improved in Kansas and across the country in the past decade. Kansas’ uninsured rate dropped from 17.5% in 2013 to 11.9% in 2023. The number of Kansas adults who said they went without care at least once because of cost decreased from 13.6% of adults in 2013 to 11% in 2023.

But those gains are at risk, said David Radley, senior scientist for the organization.

“The Congressional Budget Office estimates that legislation currently making its way through Congress would allow the premium tax credits to expire and to make it harder for low-income people to maintain their Medicaid coverage,” he said at a Tuesday media briefing.

Nine of the 10 states that haven’t expanded Medicaid, including Kansas, scored worse than the national average, according to the fund’s performance measures.

Disparities are expected to increase as federal changes to Medicaid and marketplace subsidies loom. States that haven’t expanded Medicaid, including Kansas, are still likely to see significant detrimental impacts, particularly in the marketplace, if cuts proceed.

Thirty-three percent of low-income Kansans younger than 65 pay high out-of-pocket costs for care, which increased from 29% in 2019, the scorecard found.

Black Kansans are at least three times as likely to die early from preventable and treatable causes as other racial groups. In every state, avoidable premature deaths among Black residents were elevated, but Kansas’ rate is one of the worst. Overall, Kansas’ health system underperforms for Black residents, the scorecard found. 

Sara Collins, senior scholar and vice president of the fund, said she fears federal changes could cause states to backtrack. States already struggling could fall even further behind, she said.

“Federal policy changes, both underway and proposed,” Collins said, “threaten to reverse the improvements achieved by states, exacerbate areas of slippage, and deepen geographic income and racial and ethnic disparities and health outcomes.”

The Affordable Care Act, which allowed states to expand Medicaid coverage to low-income adults, was put in place because not everyone had health insurance through an employer, Collins said. Expanded Medicaid and marketplaces subsidies were ways to address that gap, which encompassed 49 million people who lacked health insurance, she said.

“And as we make it harder for people to access both of those, we’re likely to see people just becoming uninsured because the reality is they still won’t have access to employer-based coverage,” she said.

According to a separate analysis from the Commonwealth Fund, an estimated 66,000 people in Kansas will become uninsured in the next decade if Congress allows the extra premium tax credits that subsidize health plans on the marketplace to expire.

Based on 2023 data, the scorecard ranked Kansas 35th for health care access and affordability and 50th in income disparity.