Some supporters of Medicaid expansion say that Gov. Sam Brownback’s rural health task force is little more than political cover. They say in an election year, Republican lawmakers opposed to expansion need to be seen as doing something about the financial pressures that forced a hospital in southeast Kansas to close its doors and are threatening others.
But Lt. Gov. Jeff Colyer, the person appointed to lead the group, says the governor’s critics have it wrong.
In this interview, Colyer says the working group is a serious attempt to help rural providers overcome the issues that are threatening their survival.
Colyer: The real issue for small hospitals is funding. But it is also what’s going on in their medical system. How are they dealing with Obamacare? What about the shortages of personnel, keeping doctors there? How do you get the next generation of nurses and additional medical personnel into your community and keep them there?
What we’re looking at is what does health care look like in rural Kansas over the next 50 years — and not over the next six months. And what I want to do is not have a quick answer that we have three meetings (then) you say, “This is the solution.” These are extremely complex problems. They’ve been facing the state for decades. We want to deal with them. And so everything is on the table.
Q: You say everything is on the table. Does that mean you’re going to find a way to integrate the expansion discussion into your conversation or is that off-limits?
Colyer: Medicaid expansion only gave rural hospitals $19 million out of the nearly $1 billion that was going to be spent in it. It was not going to change things.
Q: And that’s certainly true in the aggregate for rural hospitals. And yet in the case of the Independence hospital, Mercy Hospital, which closed in the fall, the hospital administrator there said the dollars that would have come through Medicaid expansion might have kept the doors open at least a little longer.
Colyer: I’m not going to comment on the situation of one individual hospital overall. We now have 75,000 more people on Medicaid than we did when we came in. We now have 90,000 more Kansans that are on Obamacare than when we came in. And yet the uninsured rate is still 10 percent.
What’s happening is we’re actually seeing the decline of commercial insurance, which has a much bigger impact on these rural hospitals. And so we’ve got to talk about the health care, you know, situation overall. That’s a bigger discussion than just the rural hospital ones. But Medicaid expansion is not the answer for solving every problem that faces us. Let’s just be realistic about it.
Q: Was the closure of the hospital in Independence, was that a triggering event for the formation of this group?
Colyer: No, this is something that we’ve been talking about for a long time. And I’ve had numerous discussions over the last few years of how do we deal with manpower issues, the economics, the changes that are going on regardless of whether you have Obamacare or not. Let’s look and see what the state can do, what communities can do and what our real needs are.
Are we going to see closures of hospitals? Probably, no matter what, in the economics. The world evolves. I don’t want to see those happen. But we’re going to do everything that we can to make sure that we get the best health care for Kansans.
Q: You mentioned workforce issues earlier. There are several of those kinds of issues swirling around the Statehouse. There is the attempt to get licensure for a mid-level provider to assist dentists. Advanced practice nurses want independent practice authority. Nurse midwives want independent practice authority. They all come to the Legislature saying: We can help you solve these problems in rural Kansas because our members are more willing to serve in those areas. Are you going to tackle those issues?
Colyer: Those are largely issues that are in the Legislature right now, and if they want to pass a bill, then we will consider whatever the Legislature puts forward to the governor.
Q: But in my experience, attending some of those hearings, the legislators are kind of at a loss as to how to evaluate those claims. Perhaps you could give them some guidance through the research and the conversations you’re going to have on rural areas as to whether or not that could be a part of the solution.
Colyer: Well, I think the legislators can get pretty good data and we’re happy to share data with them. And that was one of the things on having this commission. We wanted to make sure that we had the chairmen of the relevant committees. We wanted to make sure that we had rural legislators, that we had real decision-makers in on these. So that we can just not have a “feel good” exercise, we have something where we can work to move forward.