Supporters of expanding Medicaid in Kansas hope the story of how the conservative governor of another red state found a way to move forward will motivate Gov. Sam Brownback and Republican legislative leaders to do the same here.
They invited a delegation of hospital officials from Indiana to come and talk about how they worked with Republican Gov. Mike Pence and large GOP majorities in the Indiana Legislature to pass a conservative plan that expanded health coverage to more than 350,000 low-income residents of the Hoosier state but required them to share in the costs.
“There is no more fervent anti-Obamacare person than Governor Pence,” Doug Leonard, president of the Indiana Hospital Association, said Tuesday at a Wichita forum.
Even so, Leonard said, Pence pushed an expansion plan through the Legislature but did it “the way he thought was right for Indiana.”
Looking back, Georgiana Reynal, director of advocacy and government relations for Indiana’s St. Vincent health system, said, “We heard a million times (from Pence): ‘I’m not interested in expanding Medicaid the way it is; it’s a broken system. But I’m interested in expanding the Indiana way.’”
The plan that Pence crafted, which federal officials approved in January, uses Medicaid dollars to purchase high-deductible health insurance plans for adults making up to 100 percent of the federal poverty level, or $11,770 annually for individuals and $24,250 for a family of four.
The state then contributes money to a Personal Wellness and Responsibility, or POWER, account that beneficiaries can use to cover out-of-pocket costs. Unlike traditional Medicaid recipients, Indiana beneficiaries must pay a portion of their premiums.
Brownback and large conservative Republican majorities in the Kansas House and Senate have staunchly resisted expansion for the past three years. But struggling rural hospitals and the story of how Indiana found a way forward on the issue spurred a panel of legislators to talk Tuesday about what it might take for Kansas to pass its own alternative plan.
Senate Vice President Jeff King, a Republican whose southeast Kansas district saw a key hospital close this year, said it’s time for a serious discussion about the specifics of a Kansas plan.
"Saying ‘no’ to everything has to stop being a viable political option because there are real lives that are being affected,” King said.
‘Who’s who of Kansas health care’
King was one of four legislators who participated on a panel at the forum sponsored by a coalition of 14 Medicaid expansion supporters that included hospitals and health foundations.
A crowd gathered early in the lobby of the Kansas Leadership Center before filing into the auditorium and filling every chair. The audience included legislators, advocates for people with disabilities and health organization lobbyists.
“This is a who’s who of Kansas health care,” said Ira Stamm, a Topeka psychologist and mental health advocate.
After the Indiana officials made a presentation, King said he was impressed with that state’s expansion plan. He said a Kansas plan would have to include similar cost-sharing elements to have a chance of passing.
In addition, King said the Kansas budget crisis means an expansion plan could pass only if it did not require money from the state general fund — something Indiana officials said they were also able to accomplish.
Rep. Dan Hawkins, a Wichita Republican who chairs the House Health and Human Services Committee, said legislators should work within Brownback’s Medicaid expansion guidelines.
Those include eliminating waiting lists for home and-community-based support services for Kansans with disabilities.
“That waiting list needs to be taken care of before he moves on,” Hawkins said.
Guidelines as barriers?
During a question-and-answer session, Joe O’Rourke, president and CEO of New Beginnings Enterprise in Neodesha, asked if Brownback’s guidelines, which would substantially increase the cost of expansion, were meant to preempt discussion of the issue.
Hawkins said he believed the governor was sincere in his belief that the state should use its “limited resources” to serve those with disabilities before “able-bodied” Kansans.
But after the event O’Rourke did not seem convinced.
“Some of the things he’s asking for — they’ve been trying to deal with the waiting lists for years,” said O’Rourke, whose organization serves Kansans with developmental disabilities. “It’s just barriers. It’s just barriers he’s set up to make sure it will never be achieved.”
John Monroe, a constituent services representative for Brownback, attended the event.
Asked afterward whether he could name any disability advocacy groups that support elimination of the waiting lists as a condition of expansion, Monroe said, “I’m not sure. I can’t speak to that.”
Tim Wood, who formerly ran a campaign dedicated to eliminating the lists for the Disability Rights Center, said no disability groups had adopted that position.
“Never,” Wood said. “No one has ever said that.”
Wood said the Kansas Hospital Association was right in saying that the support services covered under the Medicaid waivers are different than the medical coverage provided by expansion. He also said that the 150,000 Kansans who would gain medical coverage through Medicaid expansion would not just be “able-bodied” individuals. Some would be Kansans with disabilities who weren’t previously eligible for Medicaid.
Rural hospital concerns
Rep. Susan Concannon, a Republican from Beloit who attended the discussion as an audience member, said she believes the Kansas Hospital Association could put forth a plan that would satisfy all the conditions voiced Tuesday except for the waiting list elimination.
However, Sen. Michael O’Donnell, a Republican from Wichita who sat on the panel, said many legislators from rural areas are worried about their hospitals closing. But he said they also are concerned about expending political capital voting for Medicaid expansion only to see hospitals close for other reasons.
Rep. Jim Ward, the panel’s lone Democrat, said no plan could guarantee that there would be no future hospital closings.
He also said his party would be open to adopting a red state model for expansion.
“I believe anything that expands access to affordable health insurance would be supported by the Democratic caucus,” Ward said.
King said he’s ready to start discussing the nitty-gritty policy pieces. But he said unlike last year, expansion advocates need to propose a detailed plan.
“I don’t think this is something we can discuss entirely in the abstract,” he said.
Tom Bell, president and CEO of the Kansas Hospital Association, said such a plan is forthcoming.
“What you’re going to see this year is something a little more specific,” Bell said. “I agree with Senator King. We need to have a plan that folks can react to knowing that if something moves, where we end up is not going to be where we started.”
Brownback privatized the Kansas Medicaid program in 2013. Now called KanCare, the nearly $3 billion program is administered by three managed care organizations.
KanCare now covers about 425,000 low-income children and families, plus disabled and low-income elderly adults. Adults with dependent children are eligible for KanCare coverage only if they have incomes below 33 percent of the federal poverty level, or $7,870 annually for a family of four.
Non-disabled adults without children aren’t eligible regardless of income. Expansion would extend KanCare coverage to non-disabled, childless adults with incomes up to 138 percent of poverty, annually $16,105 for an individual and $32,913 for a family of four.
Watch a video of the forum:
Andy Marso is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team.