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Jan. 7, 2014
TOPEKA Kansas Senate President Susan Wagle said she thinks Medicaid expansion is unlikely to win approval from lawmakers this year given the shaky rollout of the Obamacare insurance marketplace.
"I think it will be very difficult to do this year because of the unpredictability of the federal plan and the instability of the plan," said Wagle, a Wichita Republican. "What we were told we were going to get (with the Affordable Care Act), we’re not getting. People were told they could keep their doctors. Now, they can’t keep their doctors. They were told they could keep their old insurance plan. They can’t keep their old insurance plan. In this environment, there isn’t much we can do."
Wagle said she still thought Medicaid expansion "deserves discussion and analysis and debate," but, "I think it’s unfortunate in that we’re in a very unpredicatable federal environment as far as implementation of Obamacare has proceeded. It’s very unpredictable what the plan will look like a year from now or four years from now. And the dynamics keep changing."
The roll-out of the insurance marketplace on Oct. 1 was fraught with problems, many of which remain unresolved, though people are now finding it easier to use the online registration and plan selection process.
Relatively few Kansans have purchased coverage through the marketplace so far, according to the latest federal reports, though the number is expected to continue growing through March, when open enrollment is scheduled to end.
The Kansas Hospital Association and the Kansas Medicaid Access Coalition will be urging state lawmakers to reconsider a broadening of the state's program, which remains one of the nation's most restrictive. Currently, Kansas Medicaid, which is called KanCare, covers poor children, the disabled and frail elderly. Childless adults are excluded regardless how poor they are.
The hospital association and the coalition, which includes more than 50 social service and consumer advocacy groups, want the state to open the program to all those earning 100 percent or less of federal poverty guidelines, which is about $11,490 a year for an individual or $19,530 for a family of three.
The Affordable Care Act provides monthly subsidies to those earning between 100 percent and 400 percent of poverty guidelines to help them buy private health insurance through the new online marketplaces created by the law.
Kansas is one of 24 states that have chosen not to expand their programs after the U.S. Supreme Court ruled in 2012 that it would be left to states to decide whether more people should be eligible. The Affordable Care Act, when signed into law in 2010, aimed to fold virtually everyone living at or below poverty level into Medicaid, a federal-state program launched in 1965.
Kansas lawmakers last year approved a measure saying that expansion could not occur here without the Legislature's express approval. But a resolution that would have rejected expansion outright failed to pass.
Expansion proponents say they are hopeful that Republicans at the Kansas Statehouse will sign off on a plan similar to those moving forward in some other Republican-dominated states that use the federal funding earmarked for expansion to enroll Medicaid beneficiaries into private health plans.
Wagle said that sort of approach would have a better chance of gaining support than a straight Medicaid expansion.
"I believe if the federal government would give us the flexibility then we could arrive at a plan that works for Kansas," she said. But she said even that would be difficult to do this year given the ongoing problems with the Affordable Care Act's implementation.
"I believe Kansas should partner with the federal government and should work toward finding solutions that cover everyone that needs to be covered," she said. "However, we don't have a predictable environment to legislate from."
Wagle said she was "excited about the Pennsylvania program," which has been proposed by that state's Gov. Tom Corbett.
That plan would use federal Medicaid dollars to buy private health coverage for the poor but also would require enrollees to pay a monthly premium and be looking for work in order to get the benefits. It also would cap the number of medical visits and tests an enrollee could receive.
The Corbett administration last month asked for federal approval of its plan but has not yet received it.
The plan drew mixed reviews in public hearings held last week in Philadelphia.
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