Medicaid expansion is more likely to be considered in the upcoming session of the Kansas Legislature if Rep. Susan Concannon is appointed to chair the House Health and Human Services Committee.
The panel is now chaired by Rep. David Crum, an Augusta Republican who has declined to hold hearings on the expansion issue for the past two sessions. But Crum is not running for a fifth term.
Concannon, a Beloit Republican and vice chair of the health committee, said she’s open to discussing expansion if the post-election political environment allows for it. She said she expects the Kansas Hospital Association to come forward with a plan.
“I do think there are some alternatives being looked at by the hospital association and I think that will come out a little more after the election,” said Concannon, whose husband is a doctor at Mitchell County Hospital Health Systems, a critical access hospital in Beloit.
Although he is more conservative than Concannon, Crum said “politics aside” she would be his choice to take over the committee.
“I just think she has the understanding of health care issues and has been very effective as the vice chairman of the committee,” Crum said.
Committee chairmanships are assigned by the House speaker and generally reflect the leadership's political philosophies.
“I can’t get involved in all the politics of it,” Crum said, “and obviously I won’t be part of the politics of it.”
House Speaker Ray Merrick, in a statement released by his office, said committee assignments will not be discussed until December.
Concannon is unopposed in the general election. She said she has not spoken with Crum or Merrick about the health committee chairmanship but is interested in the post and would be disappointed if she’s not chosen.
Under the Affordable Care Act spearheaded by President Barack Obama, Medicaid coverage was to be extended to all families earning up to 138 percent of the poverty level, including an estimated 151,000 Kansans. The cost of the expansion would be borne entirely by the federal government through 2016 and then phase down to a 90 percent/10 percent federal-state partnership by 2020.
The state would continue to pay approximately 40 percent of the cost of covering Kansans previously eligible for Medicaid.
After a legal challenge to the law, the U.S. Supreme Court ruled that states could not be forced to expand Medicaid. About half the states, including Kansas, have chosen not to.
In Kansas, Medicaid expansion has been a political non-starter for conservatives who staunchly oppose the health reform law, also known as Obamacare, and have expressed doubt that the federal government will meet its funding obligation.
But the state’s hospitals stand to lose federal money for uncompensated care because the federal law assumed Medicaid expansion would reduce the state’s uninsured population.
Rep. Tom Moxley, a Republican from Council Grove, said the combination of not expanding Medicaid and losing uncompensated care funds could doom some small-town hospitals.
“Medicaid expansion seems to be extremely important to rural hospitals that are suffering through a real hardship period now, anyway,” Moxley said. “If they don’t get assistance, we’re going to lose some of them.”
Hospitals in urban settings that care for large numbers of uninsured Kansans also could be squeezed financially.
Moxley also pointed to low-income Kansans who would have been covered by the expansion but now find themselves in a coverage gap. They make too much to qualify for Medicaid but not enough to qualify for federal subsidies to buy private insurance on the online marketplace also established by the ACA.
Moxley, also unopposed in the upcoming election, said he hopes that the new health committee chair, whoever it turns out to be, will schedule hearings on the expansion issue.
Senate President Susan Wagle, a conservative Republican from Wichita, has expressed some openness to accepting federal money for Medicaid expansion under an alternative model, like one used successfully in Arkansas to give premium assistance to those buying private plans on the marketplace.
Concannon said she thinks the Kansas Hospital Association plans to propose something different from the Arkansas plan, “but it’s another way to get to the same result.”
“With my background coming from a family of providers and understanding the critical access hospitals, it would certainly be something we should look at,” Concannon said.
Concannon said she understands the struggles that small-town hospitals face.
In 2008 she started a foundation to aid the hospital where her husband works, which she calls one of the “anchors” of small-town life. A shrinking tax base made it a challenge to fund the hospital, she said.
One of her first projects involved raising funds to build an acute care wing.
“In our little town of 4,000 and the area around us, I raised $3.1 million over a five-year pledge period,” Concannon said.
The foundation also raised the money to purchase a 140-year-old limestone house next to the hospital. The lower level serves as the foundation's offices, while bedrooms on the upper levels are reserved for out-of-town families with hospitalized next of kin.
"Kind of like a mini-Ronald McDonald house,” Concannon said.
Concannon still volunteers at the foundation, but she stepped down as executive director last year to focus on her legislative duties.