The Kansas health insurance marketplace
When it comes to the Affordable Care Act, Kansas has maintained a stance of reluctance. The Sunflower State is among those that have not expanded Medicaid under the Affordable Care Act, and defaults to the federally run health insurance exchange – albeit with a marketplace plan management model for the exchange.
Open enrollment for 2020 health plans has ended. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020. But Kansas residents with qualifying events can still enroll or make changes to their coverage for 2020.
- Blue Cross Blue Shield of Kansas
- Sunflower State Health Plan/Ambetter from Sunflower Health (Centene)
Kansas enrollment in qualified health plans
In Kansas, 57,013 people signed up for a qualified health plan through the state’s federally-run exchange during 2014 open enrollment.
By 2016, enrollment was almost double that of the initial ACA open enrollment period, with 101,555 people enrolled in private health plans through the Kansas exchange. But enrollment has steadily declined since then, as has been the case in the majority of the states that use HealthCare.gov. 85,880 people enrolled during the open enrollment period for 2020 coverage.
Kansas and Medicaid expansion
Medicaid is called KanCare in Kansas. Kansas is among the states that have not yet expanded Medicaid under the ACA.
The state’s decision against Medicaid expansion leaves 46,000 Kansans in the coverage gap, meaning they neither qualify for Kansas Medicaid nor for tax subsidies to help purchase private coverage through the marketplace.
Former governors Sam Brownback and Jeff Colyer, both Republicans, were strongly opposed to Medicaid expansion. But Governor Laura Kelly, a Democrat, took office in 2019 and identified Medicaid expansion as one of her top priorities. Medicaid expansion legislation passed the House in Kansas in 2019, but died in the Senate. The issue is likely to be revisited in 2020.
In Kansas, 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 33 percent of the federal poverty level.
Read more about Medicaid expansion and Kansas.
Short-term health insurance in Kansas
Kansas law limits short-term health plans to initial terms of not more than twelve months (ie, the same as the federal rules that took effect in late 2018). But the state only allows short-term plans to renew one time, so the maximum duration is two years. So the three-year maximum duration allowed under federal rules does not apply in Kansas.
Read more about short-term health insurance in Kansas.
Is the ACA helping in Kansas?
According to US Census data, the uninsured rate in Kansas dropped from 12.3 percent in 2013 to 8.7 percent in 2016, and remained at that level in 2017. It grew slightly in 2018, to 8.8 percent, although it was still slightly lower than the national average, despite the fact that Kansas has not expanded Medicaid (nationwide, there has been an uptick in the uninsured rate under the Trump administration).
As of mid-2019, there were 72,731 people in Kansas who were receiving premium subsidies in the exchange to offset the cost of their individual market health insurance premiums. Nearly 37,000 of them were also receiving cost-sharing subsidies to reduce their out-of-pocket costs.
Kansas and the Affordable Care Act
Kansas is a Republican-controlled state, with voters favoring Donald Trump by a wide margin in the 2016 election. Republicans still hold a strong majority in the state’s legislature, but Democrat Laura Kelly became governor in 2019.
Kansas currently has just one Democrat in its Congressional delegation — Rep. Sharice Davids, who took office in 2019 and supports the ACA. The rest of the Congressional delegation from Kansas is opposed to the ACA.
Kansas joined the 2010 lawsuit challenging the constitutionality of the ACA (the Supreme Court ultimately upheld most of the law, but ruled that states could opt out of Medicaid expansion without losing the rest of their federal funding for Medicaid; Kansas has not expanded Medicaid). The state is also challenging the ACA in Texas v. Azar, as one of the 18 plaintiff states seeking to overturn the entire ACA now that the individual mandate penalty has been eliminated.
Former Gov. Sam Brownback was a vocal critic of the ACA. 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.
The Kansas high-risk insurance 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 successfully terminated in mid-2015 following significant communication with members about transitioning to the private market.
Medicare coverage in Kansas
As of November 2019, there were 537,988 Medicare beneficiaries in Kansas. Most Medicare enrollees in Kansas opt for Original Medicare, with just 16 percent selecting Medicare Advantage plans.
You can read more about Medicare in Kansas in our state Medicare guide.
State-based legislation in Kansas
In April 2016, Kansas enacted HB2454, legislation that allows health insurers to offer EPO plans with narrow networks and “gatekeeper” requirements similar to HMOs.
HB2066, which would have expanded Medicaid in Kansas, passed the House in 2019 but stalled in the Senate.
Scroll to the bottom of this page to see a summary of what’s happening legislatively in Kansas with healthcare reform at the state level.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.