The best that can be said of expanding Medicaid eligibility in Kansas is that it’s a journey.
At a well-attended forum on Tuesday at Johnson County Community College, Sen. Jeff King, an Independence Republican, predicted that expansion is at least 16 months away.
“It’s not going to be short. It’s not going to be easy. It may not be this year,” King said.
He’s right about the long and difficult part. Kansas already has stalled so long it has passed the three-year window in which the federal government would pay the full cost of the expansion. Ditto for Missouri.
About 150,000 people in Kansas and twice that many in Missouri are believed to be uninsured because of the states’ failure to increase Medicaid eligibility to the threshold called for in the federal Affordable Care Act.
But King’s presence and posture at the event — sponsored by local chambers of commerce, hospitals and businesses — signified a sort of progress. The senator is conservative on most issues and used to avidly oppose expanding Medicaid.
Then Mercy Hospital of Independence closed because of financial problems, leaving the town without a hospital.
“The hospital I was born in, the hospital my kids were born in, is gone,” King said. “I know Medicaid expansion is not a panacea, but my constituents would have other options if we had it.”
King did something rare for politicians today. Instead of digging in on his party’s ideology, he did some research.
It involved spending a day with Dr. Julie Griffin, who runs a health center in Coffeyville, Kan. King met some of Griffin’s patients — people who work hard for low pay and suffer the health effects of poverty. Some were slowly dying, King said. The encounters changed his perspective. He now wants to consider a “Kansas-based” Medicaid expansion plan, one that won’t cost the state’s general fund and is done through private insurers.
King’s stance is a far cry from an email missive sent out by Gov. Sam Brownback’s deputy communications director in October.
“Medicaid expansion creates new entitlements for able-bodied adults without dependents, prioritizing those who choose not to work before intellectually, developmentally and physically disabled, the frail and elderly, and those struggling with mental health issues,” Melika Willoughby wrote. “This isn’t just bad policy, this is morally reprehensible.”
Brownback and Willoughby should take a page from King’s book and get to know some potential Medicaid recipients before they deride them as lazy couch surfers. Perhaps they, too, should spend a day with Griffin.
Doug Leonard, president of the Indiana Hospital Association, addressed that topic.
“The fact that we have turned ‘able-bodied people’ into a pejorative is wrong,” he said. “There’s a personal story with each one of those people.”
Leonard was in attendance to talk about the Healthy Indiana Plan, which expands Medicaid eligibility to state residents who make up to 138 percent of the poverty level. It requires all participants to make a monthly payment, ranging from $1 to $27, depending on family size and incomes. Those contributions fund “personal wellness and responsibility” accounts, which work like health savings accounts.
Experts say the Indiana plan stresses personal responsibility more than other states’ expansion mechanisms, making it attractive to conservative states still considering the move.
The Indiana plan has covered 136,000 former Medicaid recipients and an additional 219,000 newly eligible subscribers, Leonard said. Nearly 1,000 new medical providers, including 335 physicians, have joined the network.
Indiana is paying for its portion of the expansion through a higher tobacco tax and payments from hospitals, Leonard said. It is not expected to cost the general fund.
Sen. Jim Denning, an Overland Park Republican, called Indiana’s plan “unsustainable” and predicted it would cost the state money as early as next year.
Asked for his source on that forecast, Denning cited a pessimistic blog post on the Forbes website. Leonard said Indiana Gov. Mike Pence’s administration already had rebutted many of the allegations in the post, and he described the post as “really nonsense.”
Several analyses, including one recently done for the Kansas Hospital Association, have projected that Kansas could afford its share of Medicaid expansion through new revenues from providers and by shifting current state costs, such as health care for prisoners and individuals with mental illnesses, into the Medicaid program.
Denning said he didn’t believe that expansion in Kansas would ever be “budget neutral.”
The forum provided for the kind of substantive discussion of Medicaid expansion that the Kansas Legislature refuses to have. While nearly all Democrats and a number of Republicans favor it, conservatives who control the House and Senate refuse to move forward. Recently, House leadership booted three moderate Republicans who support expanded eligibility off the committee that considers health issues.
Besides lawmakers, the forum included businessman Terry Dunn, former Kansas Department of Health and Environment secretary Robert Moser and former Kansas Senate president Dave Kerr of Hutchinson.
All spoke repeatedly of the need for Brownback and the Legislature to “begin to have the conversation.”
But as Tom Bell, president of the Kansas Hospital Association, noted, this is the fourth year Medicaid expansion has been on the table and the only plan of action is to begin a conversation.
“That’s a problem,” Bell said.
It is. Let’s hope it doesn’t take 16 months to resolve the problem.