Kansas lawmakers urged to consider Medicaid expansion

CEO of Wesley Medical Center asks area legislators to look at broadening the program

0 | Hospitals, KanCare, Medicaid-CHIP

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Hugh Tappan

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— The chief executive of one of the state’s largest medical centers this week urged Kansas legislators to consider expanding eligibility for the state’s Medicaid program.

The original intent of the Affordable Care Act, commonly known as Obamacare, was that all states would expand their Medicaid programs effective Jan. 1, 2014 to include all adults with incomes at or below 138 percent of federal poverty guidelines.

But a subsequent U.S. Supreme Court ruling made expansion optional for states. Kansas, which is governed by conservative Republican opponents of Obamacare, is among the states that have shown no interest in broadening the program, despite entreaties from Kansas hospital officials and other groups.

Kansas currently has one of the nation’s most restrictive Medicaid programs, essentially barring all childless adults regardless how poor, unless they are elderly, disabled, or pregnant. Parents can qualify if they have income below 32 percent of poverty guidelines, which is less than $550 a month for a family of three.

Once the other coverage mandates of the Affordable Care Act kick in on Jan. 1, people with incomes between 100 percent and 400 percent of federal poverty guidelines will be eligible for federally subsidized private health coverage. But since state policymakers haven’t approved Medicaid expansion, a large number of Kansans — an estimated 58,000 — will be ineligible for the program but too poor to meet the subsidy thresholds.

“Even with the Affordable Care Act, we’re still going to have a lot of people who won’t be in a position to take advantage of the health insurance marketplace,” said Hugh Tappan, chief executive of Wichita’s Wesley Medical Center.

“They’re still going to come to us and we’re still going to see them, regardless of their ability to pay. But we need to be figuring out how a system that assumes everybody will be insured goes about covering the costs of the uninsured,” he said.

Tappan met with Wichita-area legislators in meetings on Monday and Tuesday and voiced various concerns, including problems he said the hospital has had getting paid for Medicaid services it has rendered.

“The idea of a mom and a dad with a child not being eligible for Medicaid unless they were under 32 percent of poverty — that’s a concern,” he told KHI News Service in a follow-up telephone interview.

Tappan also alerted legislators to the anticipated financial impact to Wesley if there is a 2 percent reduction in Medicare payments as a result of the federal budget sequester.

“Two percent is a lot,” he said. “We probably should have done more to let people know about it, but we were all too busy dealing with KanCare.”

The Kansas Health Consumer coalition also is working to persuade Kansas policymakers to open up the Medicaid program to more people, and the Kansas Hospital Association earlier this year began a separate campaign pushing for expansion.

According to studies commissioned by the hospital association, Medicaid expansion would pump more than $3 billion into the state economy and create 4,000 new jobs by 2020.

But the state's Republican political leaders have said they are unconvinced the federal government would continue to cover the costs of new Medicaid enrollees, eventually leaving the state to either pick up the tab or cut people from the program.

The hospital association also did a poll that showed 60 percent of Kansans favored Medicaid expansion.

KHI News Service coverage of Medicaid expansion

Medicaid Access Coalition launches online "ticker" showing foregone federal dollars (2/13/14)
→ KHI report: Nearly 182,000 Kansans in the ‘Eligibility Gap’ (1/11/14)
House speaker says Medicaid expansion is "up to the governor" (1/10/14)
KS Senate president says Medicaid expansion unlikely to gain approval this session (1/7/14)
Profiles of the coverage gap: Kathleen Christian (1/6/14)
Efforts continue to expand Medicaid in Kansas and Missouri (1/6/14)
Hospital association hires former Bush HHS secretary to help craft a plan Kansas Republicans might support (12/23/13)
Iowa wins approval to expand Medicaid by using federal funds to buy private insurance (12/11/13)
White House officials hold call to urge Medicaid expansion in Kansas (11/21/13)
Republican governor talks up plan to expand Medicaid — his way (10/28/13)
Challenger says Brownback owes voters a decision on Medicaid expansion (10/22/13)
Nearly 5.2M Americans fall in coverage gap in states not expanding Medicaid (10/16/13)
Sebelius: Feds flexible on how states expand Medicaid (9/22/13)
Sebelius says Kansas and Missouri are missing the boat on Medicaid expansion (9/20/13)
Medicaid expansion coalition finds strength in numbers (9/17/13)
Republican Gov. Corbett proposes expanding Pennsylvania Medicaid (9/16/13)
Kansas lawmakers urged to consider Medicaid expansion by Wesley CEO (8/29/13)
Estimating maneuver could help more people gain from Obamacare: How the poor might qualify for Affordable Care Act subsidies in states that don't expand Medicaid (8/12/13)
Report: States not expanding Medicaid stand to benefit most from doing so (7/18/13)
CMS won’t penalize hospitals in states slow to expand Medicaid (5/14/13)
Insurer Centene: We can do Arkansas-style Medicaid (5/14/13)
The Arkansas Medicaid Model: What you need to know about the 'private option' (5/2/13)
Nothing to be done about coverage gap in states not expanding Medicaid, feds say (4/29/13)
Brownback says he's listening to Medicaid expansion proponents, opponents (4/5/13)
Oregon shows costs of putting Medicaid enrollees in private coverage (3/29/13)
Governor urged to expand Medicaid eligibility (3/27/13)
Arkansas Medicaid expansion attracts other states' interest (3/26/13)
Senate president prefers options remain open on Medicaid expansion (3/25/13)
States urged to expand Medicaid with private insurance (3/22/13)
Senate budget amendment underscores opposition to Medicaid expansion (3/21/13)
Study: Kansas employers face millions a year in possible penalties without Medicaid expansion (3/15/13)
More than 30 Kansas groups pushing for Medicaid expansion (3/12/13)
Health insurers see big opportunities in health law’s Medicaid expansion (3/8/13)
Medicaid expansion supporters to step up lobbying efforts (3/7/13)
Budget committee hears resolution opposing Medicaid expansion (2/22/13)
Legislators focusing on Medicaid expansion cost estimates (2/19/13)
Kansas hospital group study predicts expanding Medicaid would generate 4,000 jobs (2/18/13)
Brownback officials release their cost projections for Medicaid expansion (2/8/13)
Medicaid expansion bill introduced (1/22/13)
Kansas hospitals worried about loss of dollars for charity care (1/14/13)
Brownback compiling own estimate of Medicaid expansion cost (12/20/12)
Group urges Brownback to expand Medicaid eligibility (11/9/12)
Debate begins on possible Kansas Medicaid expansion (10/25/12)
Amerigroup CEO says states ‘need’ to go along with Medicaid expansion (7/11/12)
Kansas hospitals ready to get on with federal health reform, spokesman says (7/2/12)
Kansas AG claims partial victory in health reform case (6/29/12)
High court upholds Affordable Care Act, but ruling puts limits on Medicaid expansion (6/28/12)

Commentary
→ Kansas Hospital Association: An opportunity for the Kansas Medicaid program
→ Americans for Prosperity-Kansas: Well-intentioned policies do more harm than good
→ Health Reform Resource Project: The cost of not expanding Medicaid
→ Rep. Jim Ward: Medicaid expansion essential for healthier Kansas
→ Rep. David Crum: Reasons for opposing Medicaid expansion
→ National Academy for State Health Policy: Much ado about Arkansas: Medicaid in the insurance exchange

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