Federal cutbacks leave Kansans with fewer options to make health care decisions

President Donald Trump's One Big Beautiful Bill Act eliminated 90% of the funding for the Navigator program, which supported experts in Medicaid and the Affordable Care Act to work in clinics throughout the state to help Kansans enroll or determine if they were eligible for the programs. (Photo by Alex Brandon - Pool/Getty Images)

TOPEKA — The federal government cut 90% of funding for a program that helps people enroll in Medicaid and the Affordable Care Act marketplace, leaving Kansans with fewer options for help understanding their health care options. 

The Navigator program paid for experts throughout the state to help Kansans understand program eligibility and the complex systems around Medicaid and ACA, said Robert Stiles, CEO of the Community Care Network of Kansas. 

Stiles’ board of directors decided not to continue the program when funding dropped from $1.5 million annually to $150,000. Navigators will operate through other organizations, even with the reduced budgets, such as Thrive Allen County, he said. 

Stiles said his organization served 4,358 people with about 50 navigators in 10 clinics across the state. Because the notification of the change in funding came in May and his board decided to wind down the program, that wasn’t even a full year, he said. 

With changes in the One Big Beautiful Bill Act that affect health care, Stiles is concerned about the people his organization was serving.  

“These were staff that were in the community, they were in local clinics, and they could help someone with their application or help them understand what they needed to submit, or kind of work to get them back on Medicaid or their health insurance,” he said.

Changes in the law include getting rid of continuous eligibility, which means people on Medicaid will have to apply twice a year, rather than once a year.

 “We’re going to see less people that are able to retain insurance,” Stiles said. 

Although it’s difficult to understand the full effect of the law’s changes, Stiles said it’s estimated Kansas’ uninsured rate will jump from 9% to 12%. 

“It’s just going to be even more crucial that we have the local resources that can help people, keep people on their insurance, keep people on Medicaid, because we are going to see sort of a churning where people are going off and on and off and on,” he said. “It’s going to hurt their ability to get health care, but it’s also going to impact the hospital or the local health care clinic and their ability to get care paid for.”

Stiles said the clinics in the Community Care Network of Kansas currently receive $17 million from the state and serve 40% of the uninsured people in Kansas, along with 25% of everyone on Medicaid. 

“They serve a much higher number of those that are on the health insurance exchanges, because often with those plans there’s going to be a lot of things that are uncovered,” he said. “I think that what people don’t know is that our clinics have to provide care, and they have to put you on their sliding scale whether you’re insured or not.”

For example, if insurance says the patient co-pay is $100 but the individual is on a sliding scale, they may pay only $10 for that health care service, Stiles said. 

“We tend to sort of get people that have insurance that doesn’t cover a lot,” he said.

The clinics also offer behavioral health and dental services, and many clients don’t have dental insurance, he said.

With the number of uninsured expected to go up, Stiles is unsure what that means for the clinics in his system. He served on the team that put together the application for the Rural Health Transformation grant, a $50 billion program offered by the Trump administration to try to alleviate some of the health care challenges created by the One Big Beautiful Bill Act.   

However, although those dollars will be helpful, they’re only allowed to be used in rural communities, Stiles said. That means just 85 of Kansas’ 105 counties, and some counties that probably should get funds won’t because they’re adjacent to metropolitan areas, he said. 

“It’s not going to cover getting people on insurance. It’s not going to allow us to pay for health care for people that can’t afford it, or don’t have insurance or lose their insurance,” Stiles said. 

The funds will change the health care system in positive ways, with a strong focus on prevention and getting people healthier, he said. 

While that’s important and needs funding and programming, Stiles is worried about immediate systemic effects. 

“We’re going to have to come up with some solutions that get people healthier because the system can’t afford to do their health care when they’re uninsured,” he said. “I think people are interested and excited about some of the ideas that are coming out of that rural transformation approach, but it doesn’t really get at the problems we’re talking about today.”

Stiles remains hopeful.  

“The (One Big Beautiful Bill Act) has some impacts, and I’m not going to discount those, but so much of what we’re talking about is what we should have always been talking about,” he said. “We may not agree on how to get there, but we all should be talking about how do we make our communities places where everybody can be healthy? How do we invest in keeping people from getting sick?”

Such discussions raise tough issues such as pricing medications, such as insulin, and social drivers of health, such as access to healthy food, he said.  

“I am hopeful. This administration, our senators, our federal representatives, our state representatives, we’re having a conversation we need to have,” Stiles said. “We may not agree on how to get there, but at least we can finally agree on the conversation.”