With Kansas legislators convening for a new session Monday, health care providers throughout the state have their eyes on Medicaid expansion.
But their efforts will be complicated, if not stymied, by the prospects of upcoming elections.
“You can never know for sure how that will impact how those members will want to vote,” said Bruce Witt, director of government relations at Via Christi Health.
“With its tie to the Affordable Care Act, I would assume some would rather not want to vote on a Medicaid expansion bill that could link them somehow as supporting the ACA.”
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In 2012, the Supreme Court ruled that states could not be forced to expand Medicaid programs under the Affordable Care Act. Kansas is one of 24 states that have not expanded Medicaid.
And its eligibility requirements for the program are among the tightest in the nation.
About 369,000 Kansans lack health insurance, and about 78,000 of them fall into what’s being called the new Medicaid coverage gap.
In Kansas, childless adults do not qualify for Medicaid regardless of income, and adults who make less than about $11,400 individually do not qualify for subsidies on the marketplace at HealthCare.gov, according to the Kaiser Family Foundation.
The federal law created that gap because it assumed that those low-income individuals would be covered through Medicaid’s expansion.
Adults who have children and who make between about $8,950 and $23,550 are also in the gap; they make too much money to qualify for Medicaid, but too little to qualify for subsidies to purchase health insurance on the new federally run marketplace, according to Kaiser.
Last year, Rep. Jim Ward, D-Wichita, introduced a bill in the House to expand Medicaid. If House Speaker Ray Merrick denies debate on the bill during this session, Ward said he will attempt to get the measure before lawmakers as an amendment or proviso instead.
He also wants to set aside four days during the session for testimony on the pros and cons of expanding Medicaid.
“This is a critical issue to all Kansans,” Ward said. “We need to have the discussion and debate.”
However, some Republicans say the issue is premature
“I don’t believe we’re ready to expand,” said Sen. Michael O’Donnell, R-Wichita.
KanCare – the state’s privatized Medicaid program that went into effect a year ago and covers about 320,000 Kansans – is still in the early stages of privatization, O’Donnell said. He also cited provider complaints over systemic payment issues with the three companies that administer the program.
Republicans have also expressed concerns over the federal government’s ability to pick up most of the tab for Medicaid expansion
Gov. Sam Brownback has declined to take a position on the issue, deferring the decision to legislators. Meanwhile, House Speaker Ray Merrick, R-Stilwell, says otherwise.
“That's (the) governor's decision,” Merrick said in a recent press conference. “Whatever he decides we'll move on accordingly.”
“He can request it and then we take it up.”
Chad Austin, senior vice president for government relations at the Kansas Hospital Association, said hospitals are also concerned over payment issues with KanCare, and want to see the managed care companies subject to Kansas’ prompt payment laws, which generally require payment of health insurance claims in 30 days.
“The state should thoughtfully develop a Kansas-based solution that takes advantage of federal funds that build upon and improve the current KanCare program,” Austin said. “We see this as an opportunity to have a thoughtful discussion on what options may work for our state.”
At the end of January, Dave Sanford, CEO for GraceMed, a nonprofit clinic in Wichita, said he and other clinic members of the Kansas Association for the Medically Underserved will meet with legislators about Medicaid expansion.
Kevin Hoppock, a local family physician and legislative committee chairman for the Medical Society of Sedgwick County and the Kansas Medical Society, says it can be a challenge to find a fiscally responsible way to improve access to care.
But he’s hopeful.
“Overall, this is more likely to be a productive year from a legislative standpoint because the freshmen that were here last year now have a year under their belts. I think there is the potential to see more action on more bills,” he said.
Models for expansion
One possibility that could increase the chances for an expansion of Medicaid is to consider alternative models that other states have proposed, Via Christi’s Witt said.
“It could make (expansion) more palatable if it’s more private market based,” Witt said. “Then I could see some of those members being a little more comfortable voting on that type of model.”
For example, Arkansas has partnered with the federal government to expand coverage to adults, so the money that would have helped pay for their care under the Medicaid program can be used instead to purchase plans offered by private insurance companies on the online marketplace. Arkansas officials call this a “private option.”
Iowa has approved a similar measure but would require enrollees to pay premiums of no more than 2 percent of their annual income as well as cost sharing for non-emergency use of emergency rooms, according to the Kaiser Family Foundation.
A proposed measure in Pennsylvania is similar to the Iowa model, but would include premiums for enrollees based on income with a maximum of $25 per month for an individual and $35 per month for a household, according to Kaiser. The measure would also require qualified, able-bodied adults to register with the state Department of Labor and be actively engaged in a job search or training.
The Kansas Hospital Association has retained Mike Leavitt – former Republican Utah governor and Health and Human Services secretary under President George W. Bush – to help analyze what a Kansas Medicaid expansion plan could look like, possibly picking and choosing provisions from other states.
Medical malpractice caps
Providers say another issue that could be addressed this Legislative session is re-evaluating the non-economic damages cap for medical malpractice lawsuits.
In October 2012, the Kansas Supreme Court upheld the constitutionality of the state’s cap of $250,000, which was set in the 1980s.
“We may look at some common sense (changes) and what should be done over the next 10 years as it relates to tort reform and malpractice caps,” Hoppock said.
KHA’s Austin agrees, saying they are interested in looking at a “thoughtful approach” on adjusting the cap.
“We don’t want to disrupt the current medical malpractice environment,” Austin said. “There are a lot of considerations in place.”
Contributing: Bryan Lowry, Wichita Eagle