WICHITA MATTERS: Expanding Medicaid a Mayoral Issue

At a recent mayoral candidate forum focused on matters of health, those in attendance had the opportunity to listen to seven of the nine individuals running for mayor (Mark Gietzen and Joshua Atkinson were no shows) respond to questions about water quality, local mental health facilities, funding for transit and other transportation alternatives, Wichita’s own Community Health Improvement Plan, and more. Most of it was informative, but little of it, in my view, provided any points of distinction between the six men and one woman on the stage. There was, however, one exception.

When a question was asked whether, as mayor, any of the candidates would join with numerous other local and state groups and organizations in pushing the Kansas state government to accept the Medicaid expansion provided under the Affordable Care Act (a priority of Governor Laura Kelly which almost certainly would have happened during the last session if Kansas Senate majority leader Susan Wagle hadn’t refused to allow the matter to come up for a vote), five of the candidates–Brock Booker, Ian Demory, Amy Lyon, Lyndy Wells, and Brandon Whipple–expressed strong support for expansion, one–Marty Mork–strongly denounced the idea, and one–Mayor Jeff Longwell–punted, saying that he couldn’t settle the argument over expansion as a city leader, so instead preferred to focus his attention on finding local sources of funding for Wichita-area hospitals and the like.

Depending on your political preferences, you might find yourself on the (I think entirely wise and responsible) side of the majority of the candidates, or you might find yourself on the (I think ideologically blinkered and unreasonable) side of Mr. Mork. But for now, it’s Mayor Longwell’s comments which stay with me. Not because I agree with him–whatever the political calculations the mayor and his staff are making, I think it’s irresponsible for him to publicly decline to take a position regarding a policy so integral the cost of health care in Wichita and its region–but because his reluctance might seem reasonable to some. I want to ask why.

Longwell and his defenders could make an obvious response: city leaders have no vote when it comes to state or federal legislation, and Medicaid expansion is both. No one would deny that city leaders can work with state and federal officials to make it easier for them to get their message out, or to coordinate with different political action groups or government agencies, or to raise money, or a hundred other things. But constitutionally, cities just aren’t players, or so the response predictably goes. Municipalities operate separately from America’s overarching political structure (even more so than counties, when you get right down to it), so why should cities make engaging with state and national matters a priority?

I would respond that they should because the aforementioned “overarching political structure” of America, as you may have noticed, is not working terribly well. There is a lot of this which you can lay at the feet of partisan polarization and social media, but more of it, I would argue, is the result of national and international socio-economic and political trends. The world is simultaneously globalizing and localizing and has been for decades now–with the consequence that sovereign states increasingly cannot do, or at least cannot do with real democratic legitimacy, the increasing number of things which they cannot avoid having to do.

Climate change, immigration and refugee flows, capital concentration, terrorism, human trafficking, internet radicalization: all of it draws upon forces that are mostly beyond the scale of the national state and are experienced most forcefully on a local scale. And particularly in cities. Urbanization–in matters of the arguments over welfare, labor, food systems, schooling, racial diversity, wages, guns, sustainability, and yes, health care–is both a central instigator of, and a central receptor of, all these centrifugal and centripetal forces. And that includes even slow-growth cities in red states like Wichita. Our city may be a somewhat behind the urbanization curb of the past few decades, but it is nonetheless being shaped by, and caught up in, all these same transformations–transformations which demand, I think, political involvement.

Those who pay attention to politics have probably become used to the idea that the elected leaders of major metropolitan areas command such large economies and voting populations that when they weigh in on what their national governments are doing (or trying to do), or take direct action themselves, they carry real influence. (Seattle’s embrace of the $15 minimum wage greatly shaped the national debate, as did New York City’s tax on sodas, and Los Angeles’s insistence on protecting undocumented workers from deportation.) I would not expect Wichita’s mayoral candidates to make such grand commitments, even assuming the political will for them to do so was there. But that does not mean the same increasing willingness of urban centers to insist upon having a real voice in these debates, and to strategizing to expand their influence through the widening cracks in our political structure, shouldn’t be felt here as well.

Wichita is the largest single city in Kansas, and holds 13 percent of the entire state’s population. (Our metropolitan area includes 22 percent of the people in the state, who are, thanks to the closing of and cutbacks at local community hospitals, overwhelmingly dependent upon Wichita’s medical institutions and health care providers.) If there is any national issue that the combined effects of rising medical costs, aging and diversifying populations, opioid addiction, and socio-economic-driven depression make essential for regional cities like Wichita to fight tooth and nail about, it is, I think, whether or how we align our local health care needs with larger programs, with all the resources and regulations they carry with them.

In short, to say that Medicaid expansion is a decision which is going to be made outside Wichita’s purview is technically correct, but substantively wrong. Rather, as it is in cities like Wichita where the health care costs burden of Kansas’s population is most profoundly felt, it is in cities like Wichita where the consequences of this decision matter most–and, thus, such cities should want to make the stake of the decision clear. And that means, I think, electing people who are willing to use the city’s platform to do so.

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