Governor Laura Kelly’s Healthcare Access for Working Kansans (HAWK) Act was sold as a “middle-of-the-road” plan to expand Medicaid to 150,000 more Kansans when it was introduced during the 2025 legislative session. But there’s nothing moderate about growing a failing federal program that already leaves millions of patients nationwide waiting in line for care. Expanding bureaucracy isn’t compassion — it’s doubling down on what’s broken.
As I explained recently in my column at the American Institute for Economic Research’s The Daily Economy, America’s healthcare crisis isn’t a market failure — it’s a government failure. The U.S. now spends nearly $5 trillion a year on healthcare, almost one-fifth of the entire economy. But half of that spending never reaches a doctor or a patient. It disappears into what Dr. Deane Waldman and I call BURRDEN: Bureaucratic, Unaccountable, Rigid, Regulated, Distorted, Expensive, and Needless costs.
Our research finds that as much as $2.5 trillion in annual waste is spent on paperwork, compliance, and red tape — not on care. Those dollars don’t heal anyone; they feed bureaucracies. Expanding Medicaid in Kansas would only make this worse by adding more layers of administration without improving access to doctors.
The Myth of “Coverage”
Governor Kelly argues that expansion will “protect rural hospitals” and “ensure affordable care” by bringing billions of federal dollars to Kansas. But coverage does not equal access. Nationwide, more than 80 million Americans are enrolled in Medicaid, yet many can’t find a doctor who will take them. Reimbursement rates are so low that fewer physicians accept new Medicaid patients — especially in rural areas. Those who do are overwhelmed, leading to long waits.
This is what we call death by queue: a Medicaid card promises care, but patients wait months for appointments while their conditions worsen, or even result in death. Adding 150,000 Kansans to this system won’t shorten the lines; it will lengthen them.
Kelly also claims expansion will “create 23,000 new jobs.” But history shows most of those jobs will be bureaucratic — not medical. The Bureau of Labor Statistics projects that medical administrators will grow 23 percent over the next decade, compared to just 3 percent for physicians. America is producing more paper-pushers than healers. That’s not a sign of success — it’s the symptom of a broken system.
Medicaid Expansion Crowds Out Care
Kansas already spends more than 20 percent of its state budget on Medicaid, diverting resources from priorities like education, infrastructure, and tax relief. The HAWK Act would deepen that dependency, tying Kansas more tightly to Washington’s mandates and debt.
Supporters claim the program will be “free” to Kansans because of federal matching funds. But those funds come with strings attached — and they won’t last. When the federal share drops, Kansas taxpayers will be left footing the bill for a larger, slower, and less effective bureaucracy.
Worse, expanding Medicaid doesn’t just harm state finances. It harms innovation. By imposing government-controlled prices and rules, Washington discourages investment in new treatments and technologies. A study from the National Bureau of Economic Research shows that price caps can slash early-stage drug R&D by up to 60 percent — meaning fewer cures and longer waits for patients.
A Better Path: Empower Patients
There’s a better way forward — one that restores access, affordability, and accountability without expanding bureaucracy. The Empower Patients Initiative, which I co-authored with Dr. Waldman, lays out reforms that could transform Kansas’s healthcare system by freeing it from federal micromanagement:
- No-Limit Health Savings Accounts (HSAs): Let Kansans save and spend their own healthcare dollars tax-free, without arbitrary caps.
- Medicaid Block Grants: Give Kansas the flexibility to tailor its own system — integrating Direct Primary Care networks and local clinics that better serve rural areas.
- Direct Patient-Doctor Relationships: Cut out middlemen like insurance companies and government billing schemes so doctors answer to patients, not bureaucrats.
- Transparency in Pricing: Encourage hospitals to post real prices upfront, as successful private models like the Surgery Center of Oklahoma already do.
If we cut BURRDEN in half, $1.2 trillion could be redirected nationally from bureaucracy to patients and providers. That would reduce family costs, raise take-home pay, and expand access to care — all without growing government or debt.
The Moral Case for Kansas
This debate isn’t abstract. It’s about Kansans forced to choose between prescriptions and groceries, about rural families losing access to care, and about doctors burning out while administrators multiply. The moral case is simple: stop rationing by bureaucracy and give patients the dignity of choice.
Healthcare should not be a government favor distributed by politicians. It should be a service exchanged freely between people: doctors and patients. Expanding Medicaid won’t fix Kansas’s healthcare system — it will expand its problems. If lawmakers truly want to expand care, they should empower patients, not bureaucrats.
