The top executive at the Hutchinson Regional Healthcare System says he and other hospital officials are “baffled” by Gov. Sam Brownback’s unwillingness to expand the state’s Medicaid program.
“I have heard all the arguments, both pro and con, on Medicaid expansion, and am at a total loss as to what the downside … might be” of allowing the federal government to pump millions of additional dollars into the Kansas health care system, Kevin Miller wrote in a recent opinion piece for the Hutchinson News.
Kansas is one of 24 states that have chosen not to expand eligibility for their Medicaid programs in the wake of a U.S. Supreme Court decision in 2012 that made expansion an optional component of the Affordable Care Act, also known as Obamacare.
Brownback has said he’s not convinced the federal government will able to follow through on its promise to pay 100 percent of expansion costs through 2015 and not less than 90 percent through 2019. Expanding the program, he said, would be unwise.
In recent weeks, the governor has pushed the notion that Medicaid expansion would lead to able-bodied adults having access to government-funded health care, a move that most Kansans would oppose. Instead, he said, the state should focus its attention on reducing the years-long waiting lists for in-home services for people with physical and developmental disabilities.
But Miller said he struggled to understand why the governor’s reluctance hadn’t also shelved the administration’s interest in bringing the National Bio and Agro-Defense Facility — a $900 million project — to Manhattan, and why the administration hadn’t taken advantage of an ACA provision that allows states to shrink their Medicaid programs after three years if expansion is deemed detrimental.
“So, why is our governor so adamant in his opposition to the Medicaid expansion?” Miller asked in the opinion piece.
Eileen Hawley, a spokesperson for Brownback’s office, responded to Miller’s question in an email to KHI News Service: “As the Governor has said previously, prior to expanding Medicaid to able-bodied adults, Kansas government should focus on reducing the waiting list for our most vulnerable Kansans, Kansans with physical and developmental disabilities. Gov. Brownback and the Legislature have added services for more than 1,000 disabled Kansans to get the services they have been waiting patiently to receive.”
Miller disputed Hawley’s inference that large numbers of would-be Medicaid beneficiaries are able-bodied and choose not to work.
“The fact of the matter is that there are many, many hard-working Kansans who have jobs but who cannot access health care without great financial burden or even bankruptcy,” he said during an interview with KHI News Service.
“The decision to expand Medicaid in ways that would reach these hard-working Kansans need not be delayed while the state decides if and how to fund services for people with disabilities,” Miller said.
Miller urged readers to ask “candidates for governor and the Kansas House of Representatives” to support Medicaid expansion during the fall campaign.
The column, he said, was part of an ongoing campaign to keep the Hutchinson community informed about what’s in — and what’s not in — the Affordable Care Act.
“Most people don’t understand the ACA and all of its ramifications, how it came together and what it could do for the state,” he said. “I can honestly say that when we get to sit down with people one-on-one and show them how Medicaid expansion would affect Reno County and the state of Kansas, they’re shocked that we’re not doing it.”
Much of the ACA, Miller said, is financed with reductions in Medicare payments to health care providers.
“That’s how the ACA was sold,” Miller said. “Hospitals were told not to worry, because whatever we lost in Medicare reimbursement would be made up by the fact that all the people we’re not getting paid for now would either have insurance through the exchange or, if they were indigent, they’d be covered by Medicaid.”
The Supreme Court decision, he said, made Medicaid expansion optional but left the Medicare cuts intact.
The Hutchinson hospital, he said, is expecting a $3.5 million cut in Medicare reimbursement this year. Expanding Medicaid likely would bring in an additional $1.1 million.
“By not expanding Medicaid, we don’t get the $1.1 million and we’ll be getting $3.5 million less from Medicare,” Miller said. “So even if we expanded Medicaid in Kansas, we’d still come out with a net loss of $2.4 million, which means we’ll have less of a bottom line when it comes to things like capital improvements and technology upgrades.”
Medicaid expansion, he said, makes both ethical and fiscal sense.
“It’s just the right thing to do,” Miller said. “A lot of the folks we’re talking about here do not get the care they need because they’re fearful of getting a hospital bill they can’t afford. So what happens is they get sicker and sicker and sicker; they end up having to go the hospital anyway but with zero reimbursement.”
The double financial hit, Miller said, forces providers to write off more uncompensated care and to shift costs when they can.
“Every business costs shifts,” Miller said. “When somebody doesn’t pay their bill, it means a larger bill for everybody else.”
Miller said he sent copies of his column to legislators whose districts include all or parts of Reno County.
“I thought he laid out the issue real well, very understandable,” said Rep. Steven Becker, a Republican from Buhler. “I support his position. I put a link to it on my Facebook page.”
Becker was one of 21 Republican House members in April who voted against a bill that prohibits the governor from expanding Medicaid eligibility without legislative approval. The measure passed 68-54.
Attempts to reach Rep. Jan Pauls and Sen. Terry Bruce, both Republicans from Hutchinson, were unsuccessful.
Bruce supported the measure requiring legislative approval of expansion. Pauls, a Democrat at the time of the vote, opposed it.
Dave Ranney is senior writer/editor with KHI News Service, an editorially independent reporting program of the Kansas Health Institute.
