Archives: KHI News Service

The head of the Kansas Hospital Association said today that most of the group's member hospitals have accepted the U.S. Supreme Court decision to uphold the Affordable Care Act and are ready to embrace reform.

“The number one thing I’m hearing from my people is, ‘Oh my gosh, are we going to have to go through this health reform political debate again?’” said Tom Bell, noting that he and other health care officials had hoped the ruling would give them a clearer picture of the future.

So far, he said, that’s not happened.

“I’m not so sure that – because of our political environment – we have any more certainty today than we did last week,” he said. “It’s hard to plan.”

Bell spoke during a Kansas Health Institute-sponsored panel discussion on the court’s ruling. Also participating on the panel were:

• Bill Rich, professor of constitutional law at Washburn University School of Law.

• Kansas Insurance Commissioner Sandy Praeger.

• Jay Angoff, director of the U.S. Health and Human Services regional office in Kansas City.

Angoff told the audience that over time “cooler heads are going to prevail” as the public learns more about the law’s benefits and costs.

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→ Webcast: Discussion of the Supreme Court's Health Reform Ruling (YouTube)

→ Brief: What the Supreme Court Ruling on Health Reform May Mean for Kansans (PDF)

→ Presentation: Slides from the introductory presentation by KHI Senior Analyst Suzanne Schrandt (PDF)

Medicaid expansion

The court's decision left intact the law's requirement that everyone who can afford health insurance buy it or pay a penalty. But the ruling also made the law's planned Medicaid expansion optional for states. Several Republican governors already have said they do not intend to expand Medicaid eligibility in their states. Gov. Sam Brownback hasn't said yet what his intentions might be with respect to the expansion, which could mean as many as 130,000 additional Kansans would gain eligibility.

Brownback has said he would take no steps to implement the Affordable Care Act until after the November elections, based on the assumption that Republicans will prevail in their bid for control of the White House and Congress and then repeal the law.

If Kansas opts not to expand its Medicaid coverage, Bell said, the state’s hospitals would be put in a position of still having to care for thousands of uninsured people in their emergency rooms while losing millions of dollars in federal disproportionate share payments.

Currently, the disproportionate share payments are meant to help hospitals offset the costs of caring for the uninsured.

Under the Affordable Care Act, Bell said, the payments would be phased out because it assumes the vast majority of the hospitals’ patients will be insured under Medicaid or otherwise by 2014, when the law's major coverage provisions are scheduled to kick in.

“There are a lot of things that really need to be looked at closely,” Bell said.<a name="continued"></a>

A Wichita legislator who attended the event said he thought fellow lawmakers would act in the 2013 legislative session to authorize Kansas' participation in the Medicaid expansion.

“If you’re a legislator and the hospitals’ (profit) margins in your district are tied to their DSH (disproportionate share) payments, how do you vote against giving them more patients with insurance through a Medicaid expansion if you know there isn’t going to be anything to replace the DSH payments with?” said Rep. Jim Ward, a Wichita Democrat who serves on the House Health and Services Committee. “At what point does ideology get by the practical reality?”

Insurance exchange

Praeger said she hoped that the governor would see fit to sign a declaration letter by Nov. 16 for setting up a “partnership” exchange, or at least not oppose Praeger moving forward on it. That would allow her office to continue regulating the state’s insurance companies while the federal government runs the health insurance exchange each state is expected to have by Jan. 1, 2014. The exchanges are to be set up as online, one-stop shopping places where people can find insurance made affordable thanks to federal subsidies. States that choose not to manage their own exchange will lose that authority by default to the federal government.

Brownback's opposition to the law and refusal to prepare for it delayed Kansas' efforts to develop its own exchange.

“States that have done nothing or very little so far run the risk of giving up, at the very least, their ability to manage who goes on the exchanges, to decide how companies are evaluated and to provide the consumer assistance piece,” Praeger said. “It would be a significant giving up of state authority if we don’t move forward.”

Praeger warned that Kansas lawmakers are running out of time if they hope to avoid having a federally run health insurance exchange.

Waiting until after the election — as the governor proposes — would be impractical, she said.

About 80 people attended the panel discussion. Another 82 persons participated via the internet.

—Staff writer Mike Shields contributed to this report.