Budget committee hears resolution opposing Medicaid expansion

State's major medical providers line up against the measure

0 | Legislature, Health Reform, Medicaid-CHIP

— Expanding the Kansas Medicaid program is the "morally right thing to do," according to a spokesman for Via Christi Health, the state's largest medical provider — and if the state says no to it, the financial costs to the health system would "be greater than if we say yes."

Dr. Keven Hoppock of Via Christi, a Catholic non-profit based in Wichita, was among the spokespersons for major medical providers who testified today against House Concurrent Resolution 5013, which would declare that the "will of the Kansas Legislature is that the state of Kansas not expand Medicaid above its current eligiblity levels."

Hoppock, like several who testified, offered his comments in writing rather than appearing before committee members. But his testimony was different only in style from that delivered in person by Karen Endicott-Coyan on behalf of the three Mercy hospitals in southeast Kansas.

Keep tax dollars in Kansas

"Don't let my federal tax dollars go to fund Medicaid expansion in another state," she said. "Keep my federal tax dollars in Kansas. Take care of my neighbors, my friends, the patients we take care of at Mercy Hospital in Columbus, Fort Scott and Independence who don't have health insurance. We have to do something about the uninsured. Medicaid expansion would do that."

Kansas currently has one of the most restrictive Medicaid programs in the country. It is limited to children, pregnant women, the elderly and disabled who are poor. Adults without children are not eligible regardless of how little income they have.

The Affordable Care Act, also known as Obamacare, was passed assuming that all states would expand their Medicaid programs to cover adults earning up to 138 percent of federal poverty guidelines. But the law was challenged in court by 25 states, including Kansas. The U.S. Supreme Court upheld most of the law but ruled that states could not be required to expand Medicaid.

Now, governors and legislatures across the country are deciding whether their states will open up Medicaid to new enrollees or not. Some conservative GOP governors who previously opposed Medicaid expansion now say they support it, most recently Gov. Rick Scott of Florida.

Kansas Gov. Sam Brownback, also a conservative Republican who opposed the health reform law, hasn't said yet if he would support Medicaid expansion. The resolution before the committee is intended to deliver him a strong message that the GOP-dominated Kansas Legislature is against the idea.

"Couldn't we just each send him a note," quipped Rep. Bob Grant, a Frontenac Democrat.

The only person to speak in favor of the resolution was Rep. David Crum, an Augusta Republican and member of the House Appropriations Committee.

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KHI News file photo

Rep. David Crum, R-Augusta

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Among other things, Crum said, the federal government's promise to pay 100 percent of state expansion costs in the first three years and 90 percent thereafter, was unlikely to be kept given the federal budget deficit. That would leave state taxpayers holding the bag or force the state to cut people off the program. He also said that persons earning between 100 percent and 138 percent of poverty would be able to buy government subsidized health insurance without a Medicaid expansion thanks to the Affordable Care Act and that many would probably drop their existing private health coverage in favor of cheaper, subsidized plans.

Charity

Written testimony in support of the resolution also was offered by Larry Halloran of Kansans for Liberty. Halloran also is chairman of the Wichita-South Central Kansas 912 Group. The 912 Project was launched in 2009 by TV and radio personality Glenn Beck. One of the 912 principles is: "Government cannot force me to be charitable."

"I believe it is important that we find a way to return charity to the control of citizens and extract government from the process," Halloran wrote.

It also was clear from their comments, that several members of the Appropriations Committee also support the resolution.

Despite the testimony offered by Via Christi, Stormont-Vail HealthCare of Topeka, Mercy Hospitals, and several other hospital spokesmen, Rep. Marvin Kleeb (R-Overland Park) told Tom Bell of the Kansas Hospital Association that he suspected there were many hospital administrators opposed to the Affordable Care Act and Medicaid expansion.

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Rep. Marvin Kleeb, R-Overland Park

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"Mr. Bell," Kleeb said. "I appreciate you have a difficult situation. I think a lot of your members are not for the job killing taxes, the individual mandates and the huge budget increases the state will have to take on, if we do Medicaid expansion. Are you folks lobbying Washington, D.C., or going to HHS (the U.S. Department of Health and Human Services) to see about changing things there?"

KanCare can't handle it

Bell is chief executive of the hospital group. His written testimony was clear in opposing the resolution. But his spoken remarks to the committee were more ambiguous on the question of Medicaid expansion.

At one point, he said that KanCare, the state Medicaid program, wasn't ready to handle a Medicaid expansion. He said it could be summer or end of the year before it's known if the initiative launched Jan. 1, would be able to deal with the more than 120,000 new Medicaid enrollees anticipated if the program were opened up. The program already serves about 380,000 people.

"Can KanCare handle this expansion? No way," Bell said. "Not now. But I think it shows promise."

Sheldon Weisgrau, speaking on behalf of the Health Reform Resource Project, told committee members that if Medicaid weren't expanded, most of the state's uninsured would continue to go without coverage.

"The choice for most of the uninsured isn't between KanCare (Medicaid) and private insurance. It's a choice between KanCare and nothing," he said. "If we don't expand KanCare, it will cause economic harm to the health care system. Make no mistake about it."

The committee did not vote on the measure today, but is expected to take action on it later.

Among the groups that gave written testimoney against HCR 5013 were:

  • The Association of Community Mental Health Centers of Kansas,
  • The Kansas Association for the Medically Underserved, which represents the state's safety net clinics,
  • Neosho Memorial Regional Medical Center,
  • Newton Medical Center,
  • Salina Regional Health Center,
  • National Multiple Sclerosis Society, MidAmerica Chapter,
  • Rawlins County Health Center,
  • William Newton Hospital in Winfield,
  • The Community Health Center of Southeast Kansas,
  • The Kansas Academy of Family Physicians, and
  • Shawnee Mission Medical Center.

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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