By BRYAN THOMPSON
BRYAN THOMPSON / HEARTLAND HEALTH MONITOR
A working group charged with finding “Kansas solutions” to the problems surrounding health care delivery in rural Kansas still hasn’t settled on a direction.
Near the end of Rural Health Working Group’s meeting Thursday in Salina, Rep. Jim Kelly of Independence asked the other members to at least consider what he called “the 800-pound gorilla” in the room: Medicaid expansion. Kelly thinks expanding eligibility for Medicaid might help other communities avoid the hospital closure that occurred in Independence.
“I don’t want another community to be in that position, and I don’t want rural communities all over Kansas — some frontier — to have difficulty accessing health care,” said Kelly, a Republican who is one of nine members appointed by Gov. Sam Brownback to the group. “What the final product looks like, I don’t know. Because I know that, to be acceptable, it’s probably going to have to have certain components to it. It’s going to have to be a Kansas-type plan.”
But Lt. Gov. Jeff Colyer, who leads the group, said Brownback wants its members to find solutions that don’t involve expanding eligibility for Medicaid, the federal-state health insurance program people with low incomes or disabilities.
“The charge of this commission was to discuss issues regardless of whether or not you have Medicaid expansion,” Colyer said. “Whether you have Medicaid expansion or not, we’re still going to have shortages of doctors. We’re still going to have hospitals that close. We’re still going to have shortages of nurses, and we’re going to have a number of issues as our population ages.”
Colyer said he wanted the group to look for other ways to address those issues and leave the Medicaid expansion discussion to the Legislature.
‘They want to talk about it’
That discussion is likely to be more robust in the 2017 legislative session. In previous years, Brownback allies in legislative leadership managed to block debate on the issue.
But Rep. Dan Hawkins, a Wichita Republican who is a member of the working group and chairs the House Health and Human Services Committee, said the political environment has shifted.
“The Legislature fundamentally changed during the primary,” Hawkins said. “The electorate spoke, and we need to be listening, and anybody that isn’t listening is tone deaf. I’m certainly not tone deaf. That was certainly a message that Medicaid expansion is something that people want to discuss. They want to talk about it. We’re going to do that.”
Hawkins still doesn’t favor expanding Medicaid, which in Kansas is a $3 billion privatized program known as KanCare, because of concerns that it will cost the state more than estimated. Even so, the Wichita Republican expects the House health committee to consider at least two Medicaid expansion proposals in the next session.
“We will have a discussion. We will have a committee vote, and we’ll see where it goes from there,” Hawkins said. “We’ll see what the Legislature thinks, and of course if the governor will sign whatever we were to come up with.”
Hawkins favors spending more money to shore up the network of safety net clinics across the state over expanding Medicaid.
“They are probably the most crucial thing we have for our uninsured and for our Medicaid patients,” he said.
Missed opportunity?
As executive director of the Kansas Association for the Medically Underserved, Denise Cyzman is all for giving a shot in the arm to safety net clinics. But she said Medicaid expansion has a role in that.
“If you want to invest in your safety net system, invest by allowing KanCare to expand,” Cyzman said. “It impacts all parts of the health system, but most importantly it impacts the health of Kansans, and I think that should always be first and foremost in our mind.”
Her organization estimates that Medicaid expansion would provide its 43 member clinics with a total of $8.6 million to $14.6 million in additional revenue that would cover care for at least 43,000 safety net clinic patients.
However, Cyzman holds out little hope that the working group will recommend expanding Medicaid. She sees that as a missed opportunity, especially for the thousands of Kansans who are too poor to qualify for subsidized coverage through the Affordable Care Act but not poor enough to get coverage through Medicaid.
“Many of those are folks that we serve at the safety net clinic system,” she said. “There are many more that are not accessing health care at all, because they’re not sure how they can pay for it, they’re afraid of what they might find. So ultimately when they do seek health care, they’re going to be sicker, they’re going to require more care, and it’s going to be more costly. And all of us as taxpayers end up with that burden.”
Members of the working group did show signs of agreement during Thursday’s meeting on expanding the use of telemedicine and better incorporating behavioral health care into primary care.
Colyer anticipates two more meetings for the group, in November and December, before it makes recommendations to Brownback and the Legislature at the start of the 2017 session.
Bryan Thompson is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team.
