Resistance to Medicaid expansion hurting state

The time to get serious about expanding Medicaid in Kansas was many months ago, when hospitals started warning that the failure to do so posed an existential threat.

The risk just got real in Independence, with the state’s inaction linked to Mercy Hospital’s decision to start shutting down Oct. 10. At least some leaders’ opposition may be softening.

Independence hospital officials also cited staffing problems and declines in population and Medicare reimbursement rates. But the financial woes could have been countered, if not offset, by the $1.6 million a year due Mercy Hospital under Medicaid expansion, according to the Kansas Hospital Association. About 190 jobs and $13 million in annual pay and benefits will be lost in Independence, and more closures may occur in other rural communities.

The GOP-controlled Legislature and Republican Gov. Sam Brownback haven’t wanted to go near Medicaid expansion because of its link to the Affordable Care Act. Greater Medicaid eligibility was anticipated in all states under the ACA as passed in 2010, but was made optional under a 2012 Supreme Court decision. The resulting choice was easy for the governor and his conservative allies, but there are serious consequences to not joining the 30 states that have expanded their Medicaid programs.

Because of lower reimbursement rates in Medicare and Medicaid under the ACA, Kansas hospitals will lose nearly $132 million a year as of 2016, according to the KHA. The increased federal funding from Medicaid expansion promises hospitals a net gain of nearly $231 million in revenues annually.

Just as important, expansion could newly cover perhaps 150,000 Kansans under the Brownback administration’s privatized Medicaid program, known as KanCare, which now covers about 425,000 residents who are poor or disabled.

The urgency may be hitting home for influential lawmakers such as Sen. Jeff King, R-Independence, who said last week: “As we look at states like Indiana that take a real state-centric approach to addressing the health care needs of their poor, I think that’s something that Kansas needs to strongly consider.”

Both Indiana and Arkansas have flavored their expansions with Republican ideas emphasizing the free market and individual responsibility. “I think those two both give us models, along with Rep. Sloan’s concept on the provider tax, that can be a way forward for Kansas,” King told the Lawrence Journal-World.

Rep. Tom Sloan, R-Lawrence, promoted a bill last spring under which providers would cover the state’s share of expansion costs once the federal government’s share starts dropping to 90 percent after 2016.

King’s comments are an encouraging sign – especially from a member of Senate leadership, which is seen as closer to the governor than its House counterparts. Senate President Susan Wagle, R-Wichita, has also expressed openness to expansion.

Brownback’s recent statements show no change in his thinking. But surely he and other leaders can see that their continued resistance is not doing anything to weaken or end “Obamacare,” which was barely mentioned during the first two GOP presidential debates and has helped the nation’s uninsured rate drop from 15.4 to 10.4 percent since 2012.

Instead, it’s hurting Kansans and their communities.

For the editorial board, Rhonda Holman

This story was originally published September 19, 2015 at 7:07 PM with the headline "Resistance to Medicaid expansion hurting state."