Kansas lawmakers are close to finishing their work on a bill they hope will motivate doctors and dentists to provide more charity care.
Though the measure enjoys bipartisan support, its most ardent supporters are Republican legislators who are opposed to Medicaid expansion and need something that shows voters they’re willing to help poor Kansans gain access to health care.
“You can’t say ‘no’ to everything,” said Rep. Dan Hawkins, a Wichita Republican and chairman of the House Health and Human Services Committee. “If you’re going to say ‘no’ (to Medicaid expansion), then you have to try and find other solutions that can help. That’s what I’m trying to do.”
Different versions of the measure — House Bill 2615 — have passed the House and Senate. Next week, the House will have the option of adopting the Senate’s version or requesting the appointment of a conference committee to work out any remaining differences.
Both versions of the bill contain incentives aimed at convincing more doctors, dentists and mental health providers to deliver free care to medically indigent Kansans. Participating providers would be given protection from malpractice claims for the charitable care they provide and would earn a limited number of continuing education credits.
Following Florida’s model
Based on a recent study of Florida’s Volunteer Health Services Program, which served as a model for the Kansas bill, Hawkins believes the incentives will substantially increase the amount of free care delivered across the state.
“Based on the data we received from Florida and the demographics of Kansas, we believe that this system has the potential of generating more than $18 million in free care for the neediest Kansans,” Hawkins wrote in a column distributed earlier this month to Kansas newspapers.
The study Hawkins cited was published in October 2015 by the Foundation for Government Accountability, an organization that SourceWatch describes as a “right-wing advocacy organization” active in statehouses across the country.
Lobbyists for several organizations that represent Kansas doctors and other providers don’t share Hawkins’ optimism. While they don’t oppose the bill, several said privately that they don’t believe it will produce the hoped-for results.
Rep. Barbara Bollier, a Mission Hills Republican and retired anesthesiologist, is among the skeptics.
“I’m not opposed to it,” she said. “But it just doesn’t add up.”
More importantly, Bollier said, the bill is a poor substitute for expanding KanCare, the state’s privatized Medicaid program.
“It isn’t comparable,” she said. “Most regular people get that, and certainly the physicians do.”
The bill requires the secretary of the Kansas Department of Health and Environment to provide legislators with annual reports detailing the types of providers who sign participation agreements and the number who actually deliver free care.
Politically possible?
A closer look at the Foundation for Government Accountability study shows that the Florida program isn’t coming close to meeting the health care needs of that state’s uninsured residents.
In 2014, the most recent year for which data is available, the study said providers offered the equivalent of 28,752 visits for every 100,000 qualifying residents. That means that more than 70,000 of every 100,000 people eligible for free care weren’t able to see a doctor.
Still, the 2014 numbers were an improvement over 2012, when providers offered only 18,111 visits for every 100,000 people who qualified for services.
The report also said that no doctors signed up to provide free care in the five poorest counties in Florida.
Even if the Kansas program meets his expectations, Hawkins acknowledges many needy Kansans still won’t have access to care. But he said with KanCare expansion off the table because of opposition from Gov. Sam Brownback and Republican legislative leaders, he wanted to focus on something that was politically possible.
“There are some people out there on social media and stuff that have criticized me for this,” he said. “All I can say is, ‘Do you want me to stand and do nothing? Why would you criticize if there is a possibility of helping?’”
Only uninsured Kansans classified as medically indigent would be eligible for free care under the program. That means Kansans with annual earnings under 200 percent of the federal poverty level: $23,760 for an individual and $48,600 for a family of four.
A Medicaid expansion bill backed by the Kansas Hospital Association would expand coverage to Kansans earning up to 138 percent of the poverty level: $16,242 for an individual and $33,465 for a family of four.
The expansion bill, which KHA calls the Bridge to a Healthy Kansas, has not been scheduled for hearings in the House or Senate.
Jim McLean is executive editor of KHI News Service in Topeka, a partner in the Heartland Health Monitor team.
