'Where you live matters': Kansas women have less access to affordable health care

Women in Kansas have a harder time accessing and affording health care than in most other states, according to a new report by the Commonwealth Fund.

The report, published Thursday, ranked Kansas 32nd in the U.S. based on how well the state’s health system works for women. It placed sixth out of seven states in the Plains region, ahead of Missouri.

The ranking by the Commonwealth Fund, a nonprofit foundation that researches health issues, is the organization’s first report to focus exclusively on how all states and the District of Columbia fare on women’s health and reproductive care outcomes.

Access and affordability

Kansas scored worst on issues of health insurance coverage, provider accessibility and health care affordability.

Kansas women in their reproductive years, ages 18-44, were less likely to have health insurance than the same group nationwide. They were more likely to report not visiting a doctor for a routine checkup in the past two years. Women giving birth in Kansas hospitals are nearly twice as likely to have a self-pay insurance payment source than the national average.

Sara Collins, a senior scholar at the Commonwealth Fund and the study’s lead author, said that reflects the state’s failure to expand Medicaid.

Kansas is one of 10 states that still has not done so, despite consistent pressure by advocates and the state’s Democratic governor. Republican lawmakers have resisted expansion, arguing in part that it would be too costly.

“We see a consistent pattern across these 10 states,” Collins said. “We see much higher rates of people not accessing care due to cost.”

And even though it’s easier for women to qualify for Medicaid once they become pregnant — the program pays for around 40% of births in the state — Collins said the fact that many women lack insurance before getting pregnant can contribute to adverse maternal and infant health outcomes.

“It means that women enter pregnancy having had less access to health care, particularly if they’re poor or low-income,” she said, “and probably (in a) a poorer health situation than they would be if they’d had health insurance coverage.”

Kansas has among the lowest per-capita rates of maternity care providers in the country, a signal that many women may struggle to find care.

Quality and prevention

Kansas performed better on other metrics. It has slightly lower rates of maternal and infant mortality than the national average — although the U.S. still performs worse than many other wealthy countries in these areas.

Kansas ranks near the top of U.S. states in early access to prenatal care, defined as within the first three months of pregnancy. Kansans were slightly less likely than women nationally to have cesarean sections for low-risk births, and slightly more likely to receive a postpartum checkup visit.

Despite rising syphilis cases in Kansas and nationally, Kansas women aged 15-44 are significantly much less likely to contract syphilis than Americans overall, and infants are nearly three times less likely to be born with congenital syphilis than the U.S. average.

Kansas women are also more likely to receive certain preventive health services like flu and pneumonia shots.

But the state underperformed on other health outcomes. The mortality rate for women of reproductive age was higher than the national average, 121.7 per 100,000 women compared with 110.3 overall.

Kansas women who recently gave birth were more likely than Americans overall to report having depression before, during and after pregnancy. They were also more likely to experience intimate partner violence before or during pregnancy.

The state’s mammogram rate was slightly under the national average: 74% of women ages 50-74 had received one in the past two years, compared with 77% nationally.

Reproductive care

Researchers analyzed data from 2022, the year that the U.S. Supreme Court issued its Dobbsdecision that allowed states to curtail abortion access. In the two years since, 21 states have either banned abortion or restricted it earlier in pregnancy than was previously allowed.

Joseph Betancourt, president of the Commonwealth Fund, said the analysis provides a “baseline” for tracking the impact of new abortion restrictions on women’s health care.

“It also serves as a glaring reminder that where you live matters to your health and health care,” he said. “Many (states) are failing to ensure that women can get and afford the health care they need. This failure is having a disproportionate impact on women of color and women with low incomes.”

The report found that Kansas has a higher ratio of abortion clinics for its population of reproductive-aged women than the U.S. average, emphasizing the state’s increasingly prominent role as an abortion access point.

Many women who now travel to Kansas for abortions come from the South and Southeast, regions that have some of the strictest abortion bans — as well as poorer maternal health outcomes and high rates of maternal mortality.

Since 2022, two new clinics providing abortions have opened in Kansas, and a third is expected to open this fall. A recent study by the Guttmacher Institute estimates that the number of abortions performed in Kansas rose from less than 8,000 in 2020 to around 20,000 in 2023, a 152% increase.

Republicans in the Kansas Legislature have passed several new laws in recent years aimed at further restricting access to abortion, although a number are tied up in court. Earlier this month, the state’s Supreme Court reaffirmed its position that abortion is a constitutional right for Kansas women.

Rose Conlon reports on health for KMUW and the Kansas News Service.