Kansas lawmakers meet to discuss Medicaid expansion

Fourteen major Kansas health care organizations brought Indiana health care officials to Wichita on Tuesday to talk with Kansas lawmakers about Indiana’s approach to Medicaid expansion.

Kansas has not expanded Medicaid because of political opposition to the Affordable Care Act, which was created with the intent that all states would expand Medicaid, the state- and federally funded insurance program for people with low incomes or disabilities.

Indiana’s conservative legislature and Republican governor have expanded Medicaid.

More than 220 people, mostly lawmakers and people involved in health care, attended the event Tuesday. It featured two panel discussions, one among Indiana health care officials and one among Kansas lawmakers.

Indiana panelists emphasized that Indiana’s plan pushed the envelope of traditional Medicaid expansion, yet was approved by the federal government.

It includes higher out-of-pocket costs for insured people in an effort to promote judicious decision-making about health care and also encourages employment.

Each Kansas panelist entertained certain aspects of the Indiana plan as potential policies for the state, but it’s still unclear how a Kansas expansion plan would look, or whether expansion could garner enough support to pass.

The Indiana plan

Indiana passed its expansion plan with Republican super-majorities in both of its legislative chambers and a Republican governor who openly opposed the Affordable Care Act.

In order to pass the expansion plan, Indiana lawmakers grappled with the political realities of Medicaid expansion being a part of the Affordable Care Act.

Doug Leonard, president of the Indiana Hospital Association, said that when the Supreme Court left Medicaid expansion to each state, Indiana politicians responded: “Over my dead body.”

“That was the answer then, and that would be the answer today to the question of ‘Are we going to expand traditional Medicaid?’ ” he said. “There’s no more fervent anti-Obamacare person than Gov. (Mike) Pence, so he crafted a way through this – to do it in a way he thought was right for Indiana.”

Economic reasons motivated Indiana’s state officials and hospitals, he said.

Leonard said the concerns in Indiana are similar to concerns he has heard in Kansas.

“The importance of government is not to give handouts, but give hand-ups,” he said, adding that expansion does not need to resemble a government assistance program.

Jonathan Nalli, CEO of St. Vincent Health in Indiana, connected the state’s expansion of Medicaid to improvement in long-term health and costs.

“We have to move away from this acute, episodic-level of delivery,” he said about the use of emergency services among uninsured residents.

The federal government covers most of the cost of Medicaid expansion. To cover the state portion of the cost, Indiana increased its tax on tobacco.

Indiana raised reimbursement rates for medical providers to the rate offered under Medicare as a way to expand access to health care.

Under traditional Medicaid rates, providers receive about 55 to 60 percent of the cost of care. Medicare rates reimburse at 75 percent.

Those higher rates pushed 1,000 providers to accept Medicaid patients.

On the Kansas panel, Rep. Dan Hawkins, R-Wichita, and Rep. Jim Ward, D-Wichita, highlighted higher rates as a potential way to improve access to care, particularly in rural areas.

Hurdling political divisiveness

Sen. Michael O’Donnell, R-Wichita, said he was impressed with the collaboration among Indiana politicians.

O’Donnell put much of the blame for contentious politics on media outlets.

“I think there does need to be more collaboration and cooperation and less of the political diatribes and victimization you get from things like The Wichita Eagle that, instead of trying to come up with a solution, they just decide to throw bombs and completely corrupt the process,” he said during the panel discussion.

After the forum, he said he referred only to The Eagle’s editorial board, but at the time he did not differentiate between the board and the news organization as a whole.

O’Donnell said he worries that the state would jump through hoops to expand Medicaid and still see rural hospital closures.

A study by a private research group, iVantage Health Analytics, found states that expanded Medicaid had fewer hospitals at risk of closure than states that chose not to expand Medicaid.

Asked about the results of the study, O’Donnell said he wants to see a Kansas-specific study that focuses more on local variants.

Ward said no one thinks Medicaid expansion is a guarantee that hospitals won’t close. “That doesn't mean that if we don't have a perfect answer that we shouldn’t go forward with a good answer,” he said.

Leonard, of the Indiana Hospital Association, said rural hospitals in Indiana described Medicaid expansion as a lifeline.

Sen. Jeff King, R-Independence, recently softened his stance on Medicaid expansion after Mercy Hospital closed in his district. The hospital cited lack of Medicaid revenue from the state’s decision not to expand as part of the reason behind its closure.

King remained sanguine about expansion.

“The current system of Medicaid is a broken system,” he said. “We cannot continue down that path. We certainly can’t expand it, but at the same time, recognize there is a gap and that gap needs to be addressed.”

He said he was thrilled Indiana found a solution “and hopefully we can find one here.”

This story was originally published November 3, 2015 at 3:45 PM with the headline "Kansas lawmakers meet to discuss Medicaid expansion."