Dr. Julie Stewart doesn’t want political candidates and elected officials to show up at her nonprofit medical clinic in Coffeyville for photo opportunities, grant announcements or organized tours.
Instead, the Coffeyville physician would like those officials to take a personal interest in the patients who have chosen Stewart’s Community Health Clinic of Southeast Kansas because they have no health insurance options.
“I want you to come help me take off their socks so you can see the sores of a diabetic patient who has no health insurance,” Stewart said. “And then I want you to get on the ground in front of them and wash their feet.”
Such medical procedures are more than commonplace for Stewart. In Coffeyville, medical providers and clinics have seen an increase in traffic since the October 2015 closure of Mercy Hospital in nearby Independence.
Stewart spoke Wednesday at a town hall meeting in Independence organized by the Alliance for a Healthy Kansas, which is hosting a series of meetings as it works to build support for Medicaid expansion in an election year.
The Alliance is funded by several health philanthropies including the Kansas Health Foundation, the primary funder of the Kansas Health Institute, the parent organization of the editorially independent KHI News Service.
After Mercy Hospital’s closure, Independence and the surrounding area have become ground zero for the debate over Medicaid expansion and what it means for rural health care.
$5.9 million for Montgomery County
Since the start of 2014, when the main provisions of the Affordable Care Act took effect, 31 states and the District of Columbia have expanded Medicaid eligibility to adults earning up to 138 percent of the federal poverty level, according to the Kaiser Family Foundation.
Kansas is one of 19 states that have not expanded eligibility for Medicaid. The annual income limits in expansion states are $16,242 for an individual and $33,465 for a family of four. In Kansas, only adults with dependent children are eligible for KanCare, the state’s privatized Medicaid program, and then only if their annual incomes are below 28 percent of the poverty level, which for a family of four is $9,216. Pregnant women, children and the elderly and disabled Kansans are eligible under less restrictive income caps.
Wednesday’s meeting in Independence was largely attended by political candidates and elected officials, which gave medical professionals like Stewart a platform to explain what they are experiencing since the closure of Mercy Hospital and how the lack of Medicaid expansion has sent the uninsured to emergency rooms, community clinics and jails for medical care.
Sheldon Weisgrau of the Kansas Association for the Medically Underserved in Topeka said Montgomery County has more than 3,600 uninsured residents, including about 1,400 who would be eligible for Medicaid under expanded eligibility.
“At $4,229 per person per year, that means Medicaid expansion would have brought $5.9 million to Montgomery County,” said Weisgrau, adding that expansion also could have led to the creation of as many as 38 medical jobs in Montgomery County.
“No one would ever believe that Independence could be without a hospital.”- Joanne Smith, former marketing director for Mercy Hospital in Independence, which closed in October 2015
Mark Woodring, CEO of Coffeyville Regional Medical Center, said the hospital continues to be challenged by the growing tide of uninsured persons who use its emergency room for medical care. It is the only hospital in Montgomery County.
Additionally, the hospital only receives about 20 cents on every $1 of reimbursed medical care.
“Tell me any other business that is guaranteed a loss of 80 cents on the dollar while dealing with more patients and surrounded by more needs,” Woodring said.
He added that Medicare reimbursements were pared before Medicaid expansion became a topic of debate in Kansas.
That’s because the Affordable Care Act included provisions so that states would see a reduction in Medicare reimbursements for uncompensated care under the assumption that Medicaid expansion would reduce such care.
Because Kansas has not expanded eligibility for Medicaid, hospitals like Coffeyville’s were forced to shoulder reduced reimbursement rates — and get nothing in return.
Woodring also said Coffeyville city taxpayers agreed to a half-cent sales tax initiative in April that will go toward the local hospital’s emergency department and medical operations. It marked the first time in Coffeyville history that a dedicated tax subsidy is used solely for a hospital’s services. All other sales taxes related to the Coffeyville hospital have been dedicated to building and maintenance of facilities.
Vulnerable rural hospitals
Joanne Smith, former marketing director for Mercy Hospital, said the lack of Medicaid expansion was one of several factors that led to Mercy’s decision to close last year.
She said had Medicaid expansion occurred when Mercy was going through a “discernment” process that began in 2014, the hospital could have received as much $1.6 million in additional Medicaid reimbursements.
The hospital had an estimated $3 million annual loss when it closed in 2015, so Smith said Medicaid expansion would not have solved all of Mercy’s financial woes.
However, it would have affected the bottom line to the point that closure may not have been a final solution.
“Closure was one of several options confronting Mercy officials during its discernment, but it was just one of those options that no one ever thought would happen,” Smith said. “No one would ever believe that Independence could be without a hospital.”
Weisgrau encouraged Kansas residents to take their concerns to elected officials, especially those in the Kansas Legislature where Gov. Sam Brownback and other Republican legislative leaders have blocked discussion of Medicaid expansion. Opponents of expansion cite state cost-sharing responsibilities, which begin next year, and an aversion to enlarging government health care programs.
In Kansas, some 30 hospitals, most of them in rural markets, are considered vulnerable to closure because of the lack of Medicaid expansion, Weisgrau said.
“It would be a shame that we could lose more hospitals just to get candidates to pay attention to this issue … but that’s what will happen,” he said.
That warning also went to the core of Stewart’s presentation, which contained anecdotes about uninsured patients whose conditions required advanced medical attention — far more than what her nonprofit clinic can provide.
“There are a lot of working Kansas who fall in the gap that has been caused by the lack of Medicaid expansion,” she said. “Change needs to happen.”
— Andy Taylor is editor of the Montgomery County Chronicle.