Repairing a scattered, inequitable Kansas health care system requires imagination, ambition

Kansans face a wildly disparate health care landscape, writes our columnist. Much could be done to improve the situation. (Photo by Thomas Barwick/Getty Images)

Kansas’ health system works well — if you live in the right county, have the right insurance and can find a provider. For many Kansans, none of those conditions hold.

Across the state, access to care, affordability and outcomes vary sharply depending on geography and income. While Kansas has strong health institutions and committed providers, the system remains fragmented and uneven. Costs continue to rise, access remains inconsistent, and too many Kansans struggle to get timely, affordable care.

One of the most significant structural challenges is Kansas’ decision not to expand Medicaid. As a result, an estimated 130,000 to 150,000 low-income adults remain uninsured, many of them working Kansans who earn too much to qualify for Medicaid but too little to afford private insurance, according to the Kaiser Family Foundation.

These gaps are not evenly distributed.

Southwest Kansas counties such as Ford, Finney and Seward, along with Wyandotte County in the Kansas City metro area, have some of the highest uninsured rates in the state, based on data from the Kansas Department of Health and Environment. The consequences are predictable: delayed care, increased reliance on emergency services, and higher levels of uncompensated care that strain already vulnerable hospitals.

Even where coverage exists, access is far from guaranteed. More than 80 of Kansas’ 105 counties are designated primary care shortage areas by the federal Health Resources and Services Administration. In southwest Kansas, shortages of OB-GYNs, dentists and specialists are particularly acute.

In some western counties, including Hamilton, Stanton and Morton, there are no local obstetric services at all. Women often must travel 50 to 100 miles or more for prenatal care and delivery. Oral health access is similarly limited, with most counties designated as dental shortage areas and few dentists accepting Medicaid, according to the Kansas Oral Health Coalition.

These challenges are more pronounced in frontier counties such as Greeley and Wallace, where extremely low population density makes traditional care models difficult to sustain. At the same time, southwest Kansas has a rapidly growing and diverse population, including many immigrant communities, making culturally and linguistically appropriate care essential.

Low Medicaid reimbursement rates further limit access.

Many specialists, particularly in psychiatry, orthopedics and dentistry, do not accept Medicaid patients, leading to long wait times or the need to travel significant distances for care. In practice, this creates a system where having insurance does not necessarily mean being able to use it.

Rural hospitals face similar pressures. Facilities in counties such as Edwards, Kiowa and Greeley operate on thin financial margins, according to the Kansas Hospital Association. Low patient volumes, workforce shortages and higher shares of uninsured or Medicaid patients make it increasingly difficult to sustain services. Some hospitals have already reduced services, particularly obstetric care, or closed altogether, as documented by the National Rural Health Association.

This raises a difficult but necessary question: Should Kansas aim to preserve every hospital in its current form, or redesign rural health systems to ensure access in more sustainable ways? Increasingly, the answer may lie in the latter — through regional care hubs, telehealth-supported networks and alternative service models.

Behavioral health is another area of urgent need. Shortages of psychiatrists, therapists, and substance use providers are widespread, with particularly high demand in southeast Kansas, including Labette and Cherokee counties. Community Mental Health Centers report persistent waitlists, according to the Kansas Department for Aging and Disability Services.

These access challenges translate into real differences in outcomes. Life expectancy can vary by five to seven years across Kansas counties, according to analysis by the Commonwealth Fund. Chronic illnesses such as diabetes and cardiovascular disease are more common in southeast Kansas, while southwest Kansas continues to face higher rates of uninsurance and poverty.

Housing, food access, transportation and language barriers all play a role in shaping health, yet they remain only partially integrated into the system.

Kansas is not starting from scratch. Several promising efforts are already underway.

A recent collaboration between the Kansas Department of Health and Environment and the University of Kansas Medical Center has formalized training and certification for community health workers, expanding the state’s ability to deliver care at the community level. These workers help patients navigate the system, manage chronic conditions, and address social needs.

The Kansas Rural Health Initiative is working to strengthen workforce pipelines and support rural health infrastructure. Telehealth expansion, accelerated during the COVID-19 pandemic, has improved access to behavioral health and specialty care, although broadband gaps remain a barrier in parts of Western Kansas.

These efforts point toward what a more effective system could look like.

A reimagined Kansas health system would begin by ensuring that all Kansans have continuous, affordable coverage. It would focus on distributing the workforce more effectively, not just increasing its size, and would expand team-based care models that include community health workers and telehealth.

It would also align payment systems with access and outcomes, encouraging providers to serve Medicaid patients and improving coordination across public and private insurers. Rural health systems would be redesigned to preserve access rather than institutions, using flexible models that reflect local needs. Behavioral health would be integrated into primary care, and prevention would become a focus rather than an afterthought.

This kind of transformation will not happen overnight. In the near term, Kansas can expand community health worker programs, strengthen telehealth and invest in workforce incentives. Over time, broader payment reforms and system redesign will be needed to ensure sustainability and improve outcomes.

Ultimately, success should be measured not by the structure of the system, but by results: fewer uninsured Kansans, shorter travel distances for care, improved access to behavioral health services, fewer preventable hospitalizations, and better health outcomes across all counties.

Kansas has many building blocks already in place. The question now is whether the state is willing to align policy, financing, and political will to build a system that works — not just for some Kansans, but for all.

Walter Taminang is a humanitarian health professional and physician with experience in health systems and policy. The views expressed are those of the author. Through its opinion section, Kansas Reflector works to amplify the voices of people who are affected by public policies or excluded from public debate. Find information, including how to submit your own commentary, here.