The head of the Kansas Hospital Association is taking issue with comments made by Gov. Sam Brownback at a recent news conference.
Asked about his continuing opposition to Medicaid expansion, Brownback downplayed the importance of the issue, telling reporters that innovation is more important to hospital finances than the billions of additional federal dollars that expansion would provide.
Tom Bell, the president and CEO of the hospital association, disagreed and told the governor so late last week in a strongly worded letter, which, among other things, said that expansion and innovation are complementary goals.
“Governor Brownback, the question is not whether the hospitals are looking for ways to innovate,” Bell wrote. “Rather, the question is whether the state of Kansas is doing all it can to support innovation in healthcare.”
In a phone interview Wednesday, Bell said he has yet to receive a response to the letter, which outlined a list of partnerships and advisory groups formed in part by the hospital association to help with innovation.
“If you look at what’s going on in our state or even a given county or a given city, that’s what health care people are trying to do right now, is innovate,” Bell said.
Bell’s group has pushed for Medicaid expansion under the federal Affordable Care Act for years, arguing that it would provide much-needed compensation to facilities that now are unable to recoup much of what it costs them to treat uninsured Kansans.
Expansion would provide health care coverage to as many as 150,000 Kansans — mostly adults — who currently do not qualify for Medicaid but make too little money to qualify for federal subsidies to buy private insurance.
Brownback and the Republican-controlled Legislature have resisted expansion, saying it would be costly and that they doubt the federal government will uphold its legal obligation to fund at least 90 percent of it.
Eileen Hawley, the governor's spokeswoman, said in an emailed statement to the KHI News Service that the hospitals would be better off without the ACA.
"Most of the losses to hospitals cited by Mr. Bell are directly related to reductions in federal payments to hospitals due to Obamacare," Hawley said. "The most obvious solution would be to repeal or at least reform the ACA. We will continue working with KHA in finding a solution that truly benefits rural Kansans, while not relying on an unreliable and unsustainable funding stream from the federal government.”
Bell said the arguments against expansion keep shifting as advocates address them, but any suggestion that hospitals might not benefit financially is hard to swallow.
But Bell said hospitals agreed to the ACA's reductions in Medicare reimbursements in exchange for provisions that ensured more people would have private insurance and that many previously uninsured people would gain Medicaid coverage. Even with the ACA’s reduction in Medicare payments based on things like readmissions, Bell said data from the Kansas Department of Health and Environment shows that all but 15 of the state’s 143 hospitals would see a net gain in revenue if the state expanded Medicaid.
Bell said in meetings with the governor, Brownback has pointed to rural hospitals’ reliance on Medicare as evidence that the ACA is harming thos facilities.
But Bell said the same KDHE data shows that all but four of the state’s 97 hospitals classified as rural would also see a net financial gain if the state expanded Medicaid.
Bell said the billions of additional federal dollars that would flow to providers under expansion would be especially welcome at a time when hospitals are also dealing with reimbursement cuts from the federal sequester and the state’s switch to managed care Medicaid, or KanCare, which has caused payment delays and administrative hurdles.
Bell said the hospital association is working on a number of initiatives to better share information with other health care providers. Those initiatives align well with the goals of managed care, he said, and increasing the KanCare user pool through Medicaid expansion would make those efforts more valuable.
“I think our point is that expansion would actually help with that innovation,” Bell said, “because it would allow us to take our KanCare program, which really is based on some pretty innovative principles and make that apply to more folks