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Health Policy Expert: Shift Medicaid Expansion Talk Away From ‘Eggheads’

Susie Fagan
Heartland Health Monitor

Proponents of expanding Medicaid eligibility in Kansas need to change tactics and prepare for a long process, a health policy researcher told them Wednesday.

Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University in northern Virginia, said Kansans who currently oppose expanding Medicaid aren’t likely to be persuaded by statistics from “eggheads” like himself.

“They don’t believe the sources you trust,” he told those at a Topeka forum, the third in a series hosted by health nonprofits, hospitals and several chambers of commerce. “You need people on the ground.”

Gov. Sam Brownback has said any proposal to expand Medicaid in Kansas must have a work requirement and be budget-neutral, but he will not sign any bill until Medicaid waiting lists for home and community-based services for Kansans with disabilities are eliminated.

Eileen Hawley, a spokeswoman for Brownback, said in an email Wednesday that opposition to expanding Medicaid is rooted in problems with other aspects of the Affordable Care Act, also known as Obamacare.

“Expanding Obamacare is politically toxic because it has been a tremendous failure,” she wrote. “It has cut funding to rural hospitals, broken its promise to allow people to keep their current insurance plans, and caused dramatic increases in premiums. Obamacare is the problem. Expanding Obamacare does not solve the problem.”

The ACA included a provision that would expand Medicaid to anyone earning up to 138 percent of the federal poverty level, or $33,465 annually for a family of four. It also would require states to raise Medicaid reimbursement rates, which could entice more providers to accept Medicaid patients.

The Supreme Court ruled in 2012 that states could opt out of expansion, and Kansas is one of 19 states that haven’t expanded eligibility. Kansas adults are only eligible for Medicaid if they are parents, are pregnant or have a disability. The income threshold is 33 percent of the poverty level, or $8,002 annually for a family of four.

The ACA requires the federal government to fund 100 percent of the cost of expansion from 2014 to 2016. That percentage drops in 2017, phasing down to 90 percent in 2020. Brownback and other Republicans have expressed skepticism the federal government will continue supplying its share.

The Kansas Hospital Association’s most recent attempt to move Medicaid expansion forward, known as “Bridge to a Healthy Kansas,” would require recipients to pay something toward their health care costs and include a job training requirement. Federal officials have consistently rejected work requirements in waiver applications.

The Kansas Health Institute estimates that expansion initially would extend coverage to approximately 150,000 Kansas, including about 63,000 who are now uninsured.

Nichols said Kansas, like the United States as a whole, has become politically polarized in recent years, and anything linked to President Barack Obama will be unpopular in some communities. Finding common ground on an issue like Medicaid expansion requires building a coalition of doctors, hospitals, health insurers and large employers — a process that took four years in his home state of Arkansas, he said.

“What makes these conversations possible is trust,” he said. “There are people in every community that people trust.”

Frustration with the process frequently entered into discussions from a panel of stakeholders who took the stage after Nichols spoke. Terry Deschaine, a trustee at Sumner Regional Medical Center in Wellington, said he thinks the debate isn’t likely to change unless the composition of the Legislature does first.

“We have changed this legislation to meet every objection the Legislature has, and the Legislature still refuses to have that conversation,” he said.

Sumner Regional Medical Center has been on a list of hospitals deemed at risk of closing for two years, Deschaine said. He estimated expanding Medicaid would raise the hospital’s revenues by about $700,000 a year.

“Many of our residents are in that gap where they’re working low-wage jobs” and can’t afford insurance, he said. “We’re taking care of patients, and we aren’t getting paid.”

Editor's note: Heartland Health Monitor partner KHI News Service is affiliated with but editorially independent of the Kansas Health Institute.

Megan Hart is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach her on Twitter @meganhartMC

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