The Nation tells of 'Life and Death in Brownback's Kansas'

The Nation, a weekly magazine and online news source covering American political and cultural life, wrote an in-depth feature on how Gov. Brownback's decision to not expand has impacted Kansans.

Life and Death in Brownback’s Kansas, documents the lives of specific people affected as well as the State as a whole. The article also chronicles how Kansas went from being positioned to become a case study for the Affordable Care Act's successful rollout, poised to meet the demands of a new insurance marketplace and Medicaid expansion, to being one of the 21 states refusing to expand Medicaid.

In addition to startling facts about the healthcare strategy in Kansas, Life and Death in Brownback's Kansas tells real stories about the struggles Kansans are facing, and have faced under the Brownback administration.

RaDonna Kuekelhan facing grave prognosis in her sister's home in SE Kansas.
Photo by Catalin Abagiu, courtesy of The Nation. 

RaDonna Kuekelhan, a woman from southeast Kansas, is dying. After surviving cancer and 35 rounds of radiation in the late '90s, her most difficult challenge was yet to come. Back then she had a job making motors for small appliances at Emerson Electric, and it came with a health plan. However, after Emerson shut down RaDonna could now find only temp work with no insurance plan.

In 2010 RaDonna fell ill, during a time when Kansas had one of the more restrictive Medicaid programs in the country. At the time, working parents couldn't ear more than 32 percent of the federal poverty level - or $5,859 a year for a family of three. Childless adults like RaDonna, didn't qualify no matter how much or how little they took home.

By 2011 RaDonna had a destroyed esophagus and colon cancer. She was too young to collect Social Security, and she was trying to survive on a $231-a-month pension from Emerson. Despite her diagnosis and collapsing income, as a single adult she still didn’t qualify for Medicaid. The only way into Kansas’ program was to qualify for disability—and in 2013 the state rejected her application.

As all of this unfolded, the sisters weren’t paying much attention to the debate over healthcare reform in Kansas. Medicaid expansion would give RaDonna a fighting chance, but its prospects were fading fast. Over the course of Brownback’s first months in office, any cautious support that he’d shown for Obamacare quickly evaporated, as movement conservatives made it clear that they wanted a united front in opposition to the law.

By early August, the state GOP was poised to vote on five separate resolutions demanding that Brownback and the legislature do the legal minimum to implement Obamacare and reject the innovator grant. Four days before the vote, Brownback beat the party to the punch and returned the $31.5 million. “Every state should be preparing for fewer federal resources, not more,” he declared in a statement, previewing an argument he’d use against Medicaid expansion as well. “That requires freeing Kansas from the strings attached to the Early Innovator Grant.”

In June 2012, the Court upheld the ACA’s mandate that Americans buy insurance. But the justices shocked even close Court observers by ruling that states could not be compelled to accept Medicaid expansion. Brownback and other GOP governors were now free to opt out without sacrificing funding for their current programs.

Kansas Gov. Sam Brownback

By this point, the governor had launched a stunning political offensive designed to rid the state of any remaining Republican moderates. Brownback had run on a radical platform, vowing to eliminate the state income tax, rewrite funding for public schools, create judicial elections, dismantle welfare—on and on toward a libertarian zero-government utopia. Yet once in office, he faced frequent obstruction from the Nancy Kassebaum Republicans, who still controlled the state legislature. In 2012, Brownback purged them.

Brownback now brags that he’s cut the number of people receiving public assistance in Kansas by more than half. But reducing benefits and reducing need isn’t at all the same thing. The poverty rate has remained flat. The share of children who qualify for subsidized school lunches has grown to more than 50 percent for the first time in the state’s history. And according to an analysis by the Kansas Center for Economic Growth, more than half of working-age adults who are uninsured already have jobs.

RaDonna Kuekelhan’s greatest sorrow now isn’t her failing health. Rather, it’s the dependence that being uninsured has forced upon her. Since she can’t turn to the state for help, she’s had to burden her sister’s family. RaDonna lives in their house and depends on them for everything from food to transportation.

“I think there’s a case to be made,” said Dr. Julie Griffin at the Community Health Center of Southeast Kansas, “that if we had gotten her Medicaid a long time ago, when I met her, that we would have gotten her to a specialist and they would have been able to treat her, rather than just closing off her esophagus.”

This is the hard reality of practicing medicine in a place like southeast Kansas, Griffin says. It too often leaves you defeated. “It’s so hard to be the doctor who has to reveal: ‘I’m not giving you a death sentence by telling you you have cancer. I’m giving you your prognosis because you don’t have coverage.’”

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