Expansion issue dominates discussion at Washburn forum on the Affordable Care Act
by Jim McLean, KHI News Service
Topeka – The decision by Gov. Sam Brownback and Republican legislative leaders not to expand Medicaid is denying care to thousands and costing Kansas hospitals millions of dollars, participants in a panel discussion said on Monday.
Randy Peterson, president and chief executive of Stormont-Vail HealthCare in Topeka, said that hospitals agreed to reductions in reimbursement rates for Medicare and other federal programs in exchange for increasing the number of Americans with private or Medicaid coverage. Negotiators assumed the increase in coverage would more than offset the reductions.
“The coverage hasn’t happened; the cuts did happen,” Peterson said.
Peterson said not expanding Medicaid eligibility to more low-income adults is largely responsible for a $10 million annual gap between what the reimbursement reductions are costing his hospital and the offsetting revenues that were expected.
A “ticker” on the Kansas Association of Hospital’s website keeps track of how much federal money the state has forgone since the first of the year by not expanding Medicaid. By day’s end Monday it was closing in on $110 million.
“Any Kansan that is paying federal income taxes is subsidizing all the other states that have adopted Medicaid expansion,” said Maynard Oliverius, the former CEO of Stormont-Vail HealthCare, who moderated the panel discussion sponsored by Washburn University.
In addition to Oliverius and Peterson, panelists included Cindy Samuelson, vice president of communications for the hospital association; Dr. Kent Palmberg, a Stormont-Vail senior vice president, and Kansas Insurance Commissioner Sandy Praeger.
Brownback and legislative leaders have given various reasons for opposing expansion. Initially, they questioned the reliability of the federal government’s promise to pay 100 percent of expansion costs for the first three years and not less than 90 percent thereafter. More recently, the governor has said he doesn’t want to increase Medicaid enrollment until the state can afford to serve Kansans with physical and developmental disabilities who are now on waiting lists.
Peterson said the argument that the federal government can’t be trusted to keep its funding promise “doesn’t hold water.” If that were the case, he said, the Brownback administration wouldn’t be accepting federal dollars for other programs and projects.
“We’re taking a lot of money for NBAF in Manhattan,” Peterson said, referring to the $1.1 billion National Bio and Agro-Defense Facility being built on the Kansas State University campus.
Praeger said the reform law’s continued unpopularity with Kansas voters is the reason that Republican leaders don’t want to discuss Medicaid expansion. Doing so, she said, would deprive them of a powerful wedge issue heading into the November elections.
“It’s politics, pure and simple,” she said.
Currently, most of the approximately 380,000 Kansans enrolled in Medicaid – called KanCare – are children, new mothers, the disabled and seniors in nursing homes. Able-bodied adults with children are eligible only if they earn less than 33 percent of the federal poverty level, which for a family of four is $7,770. No matter their income, adults without children aren’t eligible unless they are disabled.
Expansion would extend Medicaid coverage to all those earning less than 138 percent of FPL – about $32,500.
Nearly 80,000 uninsured Kansas are expected to fall into what is being called the “Medicaid gap,” because in addition to being ineligible for Medicaid they earn too little to qualify for federal subsidies to help them purchase private coverage.
“Absent Medicaid expansion, we’ll continue to have people fall through the cracks,” Praeger said. “I care passionately about this because it just doesn’t make sense that we’re not doing it.”
The panelists said that on balance the health reform law was making positive changes in the American health care system by forcing doctors and hospitals to provide more holistic, coordinated and evidenced-based care.
Palmberg, the Stormont-Vail vice president who oversees the hospital’s physician group, said the push for quality was evident in the new ways doctors are practicing. As an example, he said he’s watched surgeons use cell-phone applications to access the latest information from their professional associations before heading into the operating room.
“The way your doctor is thinking about your care is changing dramatically,” he said.
Each of the panelists said they would rather see Congress fix problems with Obamacare rather than continuing efforts to repeal it.
“I don’t see us going back,” Praeger said. “I’d rather see us stick with this for a while and make it work.”
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