Things were supposed to be different on the Medicaid expansion this year.
Expansion advocates thought Democratic Gov. Laura Kelly’s election would elevate the issue to center stage. They figured that would all but guarantee that Kansas would join the ranks of expansion states — now numbering 37 plus the District of Columbia.
But so far this legislative session it’s been déjà vu all over again.
Republican leaders haven’t budged in their opposition. They’ve launched social media campaigns against expansion. Blasted the governor for low-balling its cost. And refused to hold hearings on her expansion bill.
They haven’t even responded to a letter that Kelly sent “respectfully” asking them to schedule hearings.
Noting the recent closure of a few more rural hospitals, Kelly wrote that communities served by other struggling hospitals “are counting on us to do something.”
She sent the letter on Feb. 19. She’s still waiting for a response.
Sensing they couldn’t avoid the issue entirely, GOP leaders OK’d Rep. Brenda Landwehr’s plan to hold a series of roundtable discussions on expansion to, as she puts it, “get the facts out on the table.”
Expansion advocates insist the facts are already well established and that they largely buttress their case. Even so, April Holman, the head of a coalition of advocacy groups lobbying for expansion, gave a politic answer when asked if she viewed Landwehr’s roundtables as a delaying tactic.
“I’m going to take this at face value,” Holman said.
Unable to completely hide her frustration, she said the timing was “unfortunate.”
“We certainly would like to have seen this earlier in the year,” she said.
Landwehr, the chair of the House Health and Human Services Committee, has booked three days for the discussions, starting Wednesday.
Going in, Landwehr said she’s trying to keep an open mind. But she says that absent compelling evidence to the contrary, she’s likely to oppose extending coverage to tens of thousands of low-income adults — those making up to 138 percent of the federal poverty level, about $17,000 per year for a single person or $35,000 for a family of four.
“It’s not children,” Landwehr said. “It’s not pregnant women or the disabled. A lot of them are able-bodied (adults). So, why aren’t they working?”
While a majority of those who would benefit from expansion either have a job or are living in a household where at least one person works, that sentiment is at the heart of the opposition to expansion.
Medicaid, many opponents say, is for children and vulnerable Kansans, not adults they see as capable of working and purchasing private coverage.
Opponents also cite cost as an issue, noting that enrollment has exceeded expectations in most expansion states. Many also reject the claim that expansion would help struggling rural hospitals keep their doors open.
Finally, said Rep. Don Hineman, a Dighton Republican who supports expansion, many lawmakers have a rational fear of expanding an expensive entitlement program.
“As we’ve learned time and again, once you start a new government program there’s no going back,” Hineman said.
Advocates say they’re ready to address those concerns and others.
The Kansas Hospital Association has estimated that expansion would generate enough in savings, economic growth and existing fees to cover the state’s expansion costs with about $5 million to spare.
Expansion opponents are dismissive of those estimates but KHA says they’re based on what actually happened in expansion states.
Montana, for instance. Its expansion costs totaled $576.9 million in fiscal year 2017, according to a recent report from The Commonwealth Foundation. But with the federal government covering 95 percent of those costs the state’s obligation was $24.5 million. It covered that with $25.2 million in savings and offsets, leaving the state with a surplus of $700,000.
Sara Collins, a health care expert at The Commonwealth Fund and one of the authors of the report, will be in Kansas to participate in the roundtable discussions.
The KHA also has data to rebut the claim that Medicaid expansion would do little to help struggling rural hospitals. While it’s true that reversing recent reductions in Medicare payments would do more, expansion would still be significant.
In recent testimony to the House Rural Revitalization Committee, KHA President Tom Bell said expansion dollars would offset about 18 percent of the uncompensated care costs of urban hospitals. He said the same offset for rural hospitals would be 26 percent and climb to almost 45 percent for the frontier hospitals that operate in the most sparsely populated areas of the state.
It’s always good to get the facts on the table. The question is, are lawmakers open to being persuaded by them?
Jim McLean is the senior correspondent for the Kansas News Service, a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio covering health, education and politics. You can reach him on Twitter @jmcleanks.
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