Could Medicaid expansion save Kansas’ rural hospitals?
The most recent of our umpteen editorials in favor of Medicaid expansion accused Kansas Republicans of “delaying as long as possible, playing games and pulling stunts.” Republican Senate Majority Leader Jim Denning declined an interview request before the piece ran, but after its publication decided to tell us his version of events.
In an interview Monday, he accused Democratic Gov. Laura Kelly of threatening him, expressing “viciousness towards me personally,” and saying she’d compromised all she intended to on this issue.
He said that it’s in any case too late in this current session to move such a big and important piece of legislation. But he also said it would be better to delay the bill anyway to save money, and that Kelly’s “fatal error” was in not reaching out to Republicans on Medicaid expansion earlier, or maybe even at all: “Where in the hell was she?”
Kelly’s chief of staff, Will Lawrence, pushed back on each of these points, and we’ll go through each of them in detail.
But since Kelly still insists she is ready and even eager to compromise, and Denning says he too has committed to Medicaid expansion — only next year, rather than this one — there’s no reason not to go forward this minute. There’s nothing keeping them from negotiating right now, and staying at it as long as it takes.
This isn’t important for any political reason, but because 150,000 Kansans need health insurance, at long last, and not in yet another year.
Some of what Denning accused Kelly of saying behind closed doors only made her sound savvy, and tougher than we knew.
Last week, he said, the governor asked to meet with him privately 30 minutes ahead of a 10 a.m. meeting with a larger group on the subject of Medicaid expansion. At that 9:30 meeting, attended only by Kelly, Denning and their chiefs of staff, “She again threatened me,” Denning said, “with the following statement: She said if I would pass Medicaid expansion this session, she would disappear from the issue and let me take all the credit, so I could win reelection. She said if I waited until 2020, she would make sure I didn’t get any credit on Medicaid expansion and I would lose my election” next year.
So, she was willing to cede credit in order to get something important done for Kansans? Good for her, and even better for her constituents.
Denning doesn’t see it that way, of course: “She said my district had changed to Democrat ... Medicaid was the No. 1 priority of my district and that if I didn’t pass Medicaid expansion in 2019 I would lose my election.”
His district is changing, so if this is what she said, it wasn’t so much a threat as a recitation of reality.
In response, he said, “I told her I wanted to work on a comprehensive plan, not this old bill” drafted years ago, “and she responded to me that she wasn’t interested in modifying the bill at all. She had compromised enough.”
Lawrence strongly disputes that: “The governor never said anything close to that. The only thing she was not willing to negotiate on was timing.”
Kelly is known for her willingness to compromise. But even if it’s Denning’s account that’s accurate, why not call her bluff and suggest a compromise?
“She told me she didn’t have any interest hearing from the legislators coming in at 10 o’clock. She basically said you’re the only one that can make Medicaid expansion happen; the meeting will be a waste of time.”
Lawrence says, “She did not say that. Her point was he carried a lot of sway with those coming in, so if he wasn’t interested in getting this done, she was concerned whether it would be a productive conversation.”
At the larger meeting, Denning said, “I was silent” in part because that’s how he works, and in part “because I didn’t want everybody to know that she thinks this meeting is a waste of your time and she doesn’t care what you think ... She basically said she has no interest in waiting for a better bill.”
That doesn’t sound anything like the Kelly who’s known for her willingness to compromise. But again, there is an easy way to force her hand, and that’s by getting that better bill sooner rather than later.
Denning maintains it’s too late to do that this year, because “the comprehensive things I want to do will take some time. We certainly could do something this year, but again, my saying is, ‘You want it bad, you get it bad.’ Look how many times we’ve done something in a hurry on the floor and we’ve screwed it up.”
It’s late, but not too late. “They could have hearings this next week,” said Lawrence, who also challenged Denning’s contention that Kelly had never reached out to Republicans.
In his own words, Denning does not seem to feel any urgency on Medicaid. “It’s not like they’re not getting health care” meanwhile, he said of those without insurance. Some aren’t, though, and they’re certainly not getting it efficiently. “Right, not efficiently, I’d agree with that.”
But “not efficiently” means not when you need it, which means you could literally die waiting. “My wife almost died and she has very good insurance,” he said, “so it works both ways. There’s maybe 12 freestanding ERs now just in our community. That’s where folks like the group we’re talking about can go and get health care.”
Care from the emergency room is hardly ideal. “It’s not the ideal place but you get very good care. It’s very expensive, but you get good care.”
Speaking of expensive, he added that “my hesitancy in just jumping ahead without a well thought out plan is we’re going to add to this deficit spending.”
Kelly “does have a large ending balance, but she’s spending through it very very quick. This is why we want to do it right: If we can save a little bit of money and stretch this out, we should.”
Meanwhile, not only are some uninsured Kansans not getting care, but for those who do have it, the state’s already-struggling hospitals are getting stuck with the bill. Whatever your personal and political differences, please try again. And this time, somebody might want to tape the conversation.