Robert Moser, who until December was the secretary of the Kansas Department of Health and Environment, headlined a long list of Kansans asking legislators Wednesday to expand Medicaid.
In a long-awaited and much-anticipated hearing in the House Health and Human Services Committee, Moser urged legislators to look past dissatisfaction with the federal Affordable Care Act (ACA) and consider the practical implications of continuing to refuse expansion and the federal dollars that come with it.
“Expansion is critical for Kansas,” Moser said. “Our providers need it. Our people need it.”
Wednesday's hearing concerned House Bill 2319, which would compel Gov. Sam Brownback and KDHE to develop an expansion plan and negotiate with federal officials for its approval.
Proponents of the bill testified Wednesday and opponents were scheduled to testify Thursday.
Wednesday's hearing brought a standing-room only crowd that spilled out to the hallway of the Statehouse's fifth floor, where custodial staff brought in extra chairs to accommodate the overflow.
Testimony in favor of expansion came from more than 150 health care providers, business organizations, religious leaders and activists like Finn Bullers, a Prairie Village man with muscular dystrophy , and Marcillene Dover, a Wichita State University student recently diagnosed with multiple sclerosis.
Dover said there was a delay in getting her symptoms diagnosed correctly because she did not have insurance and could not afford an MRI.
“I thought ‘No way, not me, I don't have a disease. I'm 21, in the prime of my life,’” Dover said. “I didn't have insurance. Just to get diagnosed would be extremely expensive.”
Dover gets her expensive medications and neurological treatments through a patchwork of charity and public health groups. She asked the committee to think about others who are uninsured and don't have those connections.
"No one should have to go through receiving a devastating diagnosis and then feel further devastation having to figure out how they're going to pay for the health care they need," Dover said.
“Expansion is critical for Kansas. Our providers need it. Our people need it.”- Robert Moser, University of Kansas Hospital physician and former secretary of the Kansas Department of Health and Environment
A binder with hundreds of pages of written testimony was compiled by the Kansas Hospital Association, the organization that has taken a leading role in pushing for expansion because of its financial benefits to the state's hospitals.
The ACA cut Medicare payments to hospitals on the assumption that expansion of Medicaid would make up the lost revenue. But the 2012 U.S. Supreme Court decision upholding the ACA also said that states could opt out of expansion, and about half the states — all controlled by Republican legislatures — have done so.
Kansas’ privatized Medicaid program, KanCare, covers about 425,000 children and low-income, disabled and elderly adults. But that number includes relatively few non-disabled adults.
Adults with dependent children can participate in KanCare, but only if they have incomes below 33 percent of the federal poverty level, or a little more than $8,000 annually for a family of four. Adults without children aren’t eligible for coverage no matter how poor they are.
Expansion would make all Kansans with incomes up to 138 percent of poverty eligible for KanCare. The eligibility cap would be set at annual income of $16,105 for an individual and $32,913 for a family of four. Estimates vary, but it’s thought Medicaid expansion would extend coverage to between 140,000 and 170,000 Kansans.
"With one stroke, you could reduce the number of uninsured in this state almost by half," Jerry Slaughter, executive director of the Kansas Medical Society, told legislators.
Recently, some Republican governors have negotiated with the federal government for expansion plans intended to allay conservatives’ concerns about cost and government growth. Tom Bell, president and CEO of the Kansas Hospital Association, said HB2319 gave the Brownback administration the opportunity to do the same.
“This is a way to build on the current privatized Medicaid program in a way that supports the economy, in a way that's fiscally responsible, in a way that promotes personal responsibility and in a way that provides person-centered care for thousands of people who do not have it,” Bell said.
The hospital association released a study in 2013 that found accepting expansion and its federal dollars would spur $3 billion in economic growth and 4,000 new jobs by 2020.
Rep. Jim Kelly, a conservative Republican from Independence, said Medicaid expansion was not “high on his list” of things to do, until he started hearing from hospitals in his mostly rural district that are struggling mightily.
“We have one very stressed hospital,” Kelly said. “We have another that's probably not at the same level but certainly not good.”
Kelly said he’s concerned about facilities closing in part because of the failure to expand Medicaid.
Brownback and legislative leadership have thus far made no move to expand Medicaid, but Moser said Wednesday that now is the time.
Moser, a physician, now heads a heart attack and stroke unit at the University of Kansas Hospital.
He said the hospital had lost about $10 million in Medicare reimbursements per year since the ACA passed and is now absorbing about $60 million per year in uncompensated care.
“Not all of that is charity care, but with the KanCare expansion model being proposed, we believe we can cut charity care costs by 30 percent,” Moser said.
Moser said that while he was speaking on behalf of KU Hospital, his support for expansion “goes beyond hospital interests.” As one of the architects of KanCare, Moser said the program was increasing primary care for those on Medicaid, keeping them out of emergency rooms and improving their health at lower costs.
He emphasized that expansion would help Kansas’ working poor.
“The vast majority of those in the expansion population are hard-working people, some working multiple jobs,” Moser said. “The trouble is, they are not benefits-eligible at any of those jobs.”