The contentious national debate over health care swept into rural Kansas on Thursday with U.S. Sen. Jerry Moran at the center of it.
Area residents as well as people from as far as Kansas City turned out for the senator’s town hall in this town of less than 300 north of Hays. National news outlets came to watch as well, producing an event that seemed to combine spectacle with civic tradition.
Moran answered questions from a polite but persistent crowd of about 150 that flowed out of a meeting room at a community center. Planned Parenthood activists in pink shirts and rural residents in cowboy boots packed into the room.
He didn’t appear fazed by the crowd or the questions, which were often skeptical. Tensions were more often seen between audience members. At one point, a self-identified abortion opponent who asked about the topic was rebuked by the crowd.
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Moran, a reliably Republican vote, surprised some last week when he said he would have voted against the health care bill under consideration in the Senate, just hours after GOP leaders pulled it.
He now faces pressure from both sides and is a possible wild card in a chamber where Republicans can afford to lose only two votes and still pass a bill.
Moran didn’t rule out eventually voting yes or no on a bill.
Changes to the law must benefit people who are harmed and helped by the Affordable Care Act, he said. Medicaid helped drive his decision to oppose the Senate bill.
“What I saw and indicated I couldn’t support were things related to Medicaid that were very Kansas-oriented. First of all, it takes money out of Medicaid in Kansas to pay for states that expanded,” Moran said.
Expansion is a state-level decision, and Kansas has not expanded Medicaid eligibility.
Medicaid and Medicare need to adequately compensate health care providers for their services if rural areas are going to have health care, Moran said. Without that, providers could attempt to shift the costs to people who have insurance and further drive up the cost of care, he said.
”We ought to be focused on why does health care cost what it does, what can we do to reduce the unnecessary things that drive up health care costs, before we get to the point of deciding who’s paying for it,” Moran said.
Bob Cox, 73, of Hays, who had been the Moran family’s pediatrician, said, “We are experiencing an internal attack, a broken health care system.”
Rooks County, where Palco is located, has a population of a little more than 5,100, and is indicative of the rural areas where the health care debate – including changes to Medicaid – could hold potentially significant consequences.
The Senate plan would end the tax penalty the law imposes on people who don’t buy insurance, in effect erasing President Barack Obama’s so-called individual mandate, and on larger businesses that don’t offer coverage to workers.
It would cut Medicaid, which provides health insurance to over 70 million poor and disabled people, by $772 billion through 2026 by capping its overall spending and phasing out Obama’s expansion of the program. Of the 22 million people projected by the Congressional Budget Office to lose health coverage, 15 million would be Medicaid recipients.
The Senate bill would cost 120,000 Kansans their health coverage in five years, according to an analysis by the Robert Wood Johnson Foundation, based in Princeton, N.J.
“I am a product of rural Kansas. I understand the value of a hospital in your community, of a physician in your town, of a pharmacy on Main Street,” said Moran, who grew up in Plainville, a short drive east of Palco, and lived in nearby Hays for several years.
High Plains Mental Health Center, headquartered in Hays, draws 75 percent of its fee revenue from Medicaid.
At least half of the patients that come through the center, which has locations throughout western Kansas, have family incomes under $24,000 a year, the center’s director, Walt Hill, said before the event.
“It is a very large portion of the revenues and resources to deliver services, especially to some of the most needy folks, kids and adults who have been in institutions, state hospitals,” Hill said.
“My biggest concern is what might happen … with changes in Medicaid.”
Eleanor McMindes, an 86-year-old retired teacher from Hays, said she’s known the Moran family for decades. She said the bill’s impact on rural hospitals, which are already struggling, is a major concern.
“In western Kansas we have a lot of hospitals that cannot even afford to have a doctor on duty. Our doctors from Hays go out there like a day at a time,” she said.
U.S. Sen. Pat Roberts of Kansas defended the progress that has been made on the Republican bill.
The bill “helps low-income Kansans that have fallen between the cracks in the Obamacare Medicaid glitch to afford care for the first time,” he said in a statement. “Obamacare has cost Kansans their money and their choices in health care. I am certainly open to ways (the bill) can be improved, but keeping Obamacare as is — is not an option.”
Signs of conservatism
Rooks County voters went for Donald Trump by 84 percent and Moran by 87 percent in the November election.
Signs of the area’s conservatism are evident. “Choose Life” signs adorned a day care and grocery store near the town hall.
Travis Couture-Lovelady, a former Republican state lawmaker from Palco who now is a lobbyist for the National Rifle Association, said the event didn’t reflect the Palco he knows, suggesting many of the participants were not from the area.
“The pro-life question got shouted down in Palco, Kansas. I mean, come on,” Couture-Lovelady said.
The majority of the crowd appeared to be from the area, but at least a few dozen seemed to be from farther away.
Several who attended made calls for bipartisanship, and some said the Affordable Care Act should be improved rather than repealed and replaced.
“I’m so tired of the polarization and the anger and the vitriol and the spin and the lies,” John Mohn, a retired teacher who lives in Hays, said before the event.
While opponents of the GOP bill made up the crowd’s majority, several attendees said they want to see the senator support a repeal bill eventually, including his college roommate, Dan Steeples.
“Under Obamacare my health premiums have more than tripled,” said Steeples, a 62-year-old Palco resident who has known Moran since sixth grade.
“You can’t just repeal something without a replacement, and I don’t know that we have a really good replacement ready to go, but I would like to see it repealed,” he said.
Lobbyists who are regularly seen in the Kansas Capitol promoting Medicaid expansion and reproductive rights were also present.
Elise Higgins, a lobbyist for Planned Parenthood, asked one of the final questions of the event, about how individuals on Medicaid could continue accessing preventative care such as birth control without Planned Parenthood. The Senate health bill would defund Planned Parenthood.
Moran listened to the question, then responded that he didn’t have an answer that Higgins “would applaud.”
“The fact that Sen. Moran would not answer that question, even in Palco, Kansas, … I think that really speaks to how essential Planned Parenthood is,” Higgins said.
Jeff Zamrzla, who traveled from Salina, praised Moran for not offering platitudes. But he said opponents of repealing the Affordable Care Act need to keep up pressure on lawmakers, including Moran.
“We heard that he still has a lot of issues with the (federal health legislation). I think those are all good to hear from him,” said Zamrzla.
Contributing: Bryan Lowry of the Kansas City Star; the Associated Press