Alliance urging support for KanCare expansion

June 24--Kansas has forfeited about $1.24 billion in federal dollars since 2014 by not expanding KanCare, the state's Medicaid program, according to representatives of the Alliance for a Healthy Kansas.

The nonprofit organization held an educational forum Thursday night in Garden City to both educate and advocate for KanCare expansion.

"This is an issue our leaders in Topeka refuse to talk about," Sheldon Weisgrau, director of the Health Reform Resource Project, said, noting that those legislators who did want to talk about the issue were removed from committee appointments as punishment for speaking out.

"Because we can't get discussion going in Topeka, we are taking the discussion to local communities. It's up to you guys to make sure that candidates for office hear about this issue," he said.

David Jordan, executive director of the Alliance for a Healthy Kansas, said the organization launched in May and has brought together more than 100 organizations from across the state with the goal to make Kansas healthier by expanding KanCare. Garden City was the third event for the group. Jordan said the organization plans two dozen more before November.

Gov. Sam Brownback and Republican legislative leaders have blocked consideration of the issue, despite polls conducted by the Kansas Hospital Association and others that show a majority of Kansans support it.

According to Jordan, 76 percent of Kansans support a budget-neutral KanCare expansion plan. A plan was introduced this year in the Legislature, but House and Senate leaders refused to vote on the plan or even debate it.

Expansion would allow more low-income families to be covered by Medicaid. More than 150,000 people in Kansas fall into a health coverage gap. They earn too much to qualify for KanCare but too little to be eligible for financial help to buy private insurance.

But those people are still getting sick and coming to the hospital for treatment. One reason hospitals support KanCare expansion, Weisgrau said, is they treat uninsured people and those who have no ability to pay. While some opponents argue that Medicaid doesn't pay well, Weisgrau said hospitals would argue that getting 50 cents on the dollar is better than getting nothing.

One hospital, Mercy Hospital in Independence, closed last fall, and a national study performed by Maine-based iVantage Health Analytics in February indicated as many as one-third of Kansas' rural hospitals, 31 of the state's 107, are at risk of closure.

Some area hospital administrators said Thursday night that expanding KanCare might just be the difference in keeping some of them open.

Scott Taylor, president and CEO of St. Catherine Hospital in Garden City, said he frequently talks to other hospital CEOs and administrators in the region who are concerned about the issue.

"I can say with confidence, unless something changes in health care finance, not just Medicaid expansion, that the one closure we've talked about today could easily be a dozen closures -- and five or six hospitals in western Kansas are in danger of closing," Taylor said.

Taylor said many rural hospitals rely on taxpayer support to keep their doors open. Considering drops in property values for many area counties due to the downturn in the oil and gas industry, he said, their aren't as many of those tax dollars available as their once were.

While St. Catherine as a private hospital does not receive tax support, that tax support is vital for the survival of the smaller hospitals surrounding Garden City, Taylor said.

"It is a challenging time for particularly deep rural health care in southwest Kansas, and every program like Medicaid expansion stands to make some difference. One doctor in Tribune could generate enough business to keep a small hospital going," Taylor said.

Weisgrau said Finney County alone has lost millions due to the state not expanding KanCare.

According to U.S. Census Bureau figures, there are 5,924 uninsured people in Finney County. Of that, about 2,200 would be eligible for KanCare expansion, Weisgrau said.

On average, the Medicaid program for people like those who fall into the coverage gap spend about $4,229 per person, per year. Weisgrau said that means every year, Finney County alone is giving up $9.2 million in funds that would come into the county to pay for the new people who would qualify under KanCare expansion.

"My fear is our legislators are not going to pay attention to this issue until we lose a few more hospitals, and that would be a tragic way to get this through," he said.

So far, 31 states have expanded their Medicaid programs. Kansas is one of 19 states that has not. By law, expansion is funded by the federal government at no less than 90 percent. Kansas does not save money by refusing expansion -- it simply gives up the opportunity to bring tax dollars back to the state, according to the Alliance.

Brownback and other expansion opponents say the state can't afford the additional cost of Medicaid expansion. Studies by the hospital association, however, indicate expansion would pay for itself.

Taylor said KanCare expansion would mean about $2 million a year to St. Catherine.

"That's a lot of jobs at St. Catherine. And when you channel those dollars through the community, it adds up to a significant amount of money," he said.

Taylor said people who fall in the gap are still getting sick, going to the emergency room and being treated. Taxpayers then pick up the bill when they can't pay.

John Kennedy, with Greeley County Health Services, which operates an 18-bed critical access hospital, a 32-bed long term care unit, and clinics in Tribune and Wallace County, is required to see anyone regardless of ability to pay. It offers a sliding fee scale based on income level and poverty guidelines that allows a write-off of 25 to 75 percent of certain patient's bills.

Kennedy said most of those who qualify for the sliding fee scale likely would qualify for expanded KanCare coverage, and that would free up tax dollars for expanding services or perhaps to help recruit an additional doctor, which is exceedingly hard to do in rural areas.

Kennedy said recruiting nurses is also difficult. He said the hospital has offered a $5,000 signing bonus to attract nurses and "did not get a nibble" of interest.

"To me, that's a lot of money, but it's not enough to get a nurse to come to Tribune," he said. "We're in this together. If Greeley County closes, do you (Garden City) want to take all our emergency room patients without them being seen by our docs first? I don't think so."

Taylor indicated if Medicaid expansion allowed a small hospital to have enough money to bring in one additional doctor, it could mean a lot to both a hospital and a community's vitality.

Several speakers Thursday indicated that opposition to expansion appears to be more about ideology and opposing anything to do with Obamacare than for practical reasons.

Dr. Michael Shull, who has been practicing in Garden City since 1988, found the fact that the state has left $1.2 billion on the table "just astounding."

"Right now, there's $1.2 billion that we didn't want to take because of ideology. I think these same people, if their house were burning down and the Obama Fire Department pulled up, they'd say, 'Stay away from here.' That's exactly what we're doing," Shull said.

Those interested in learning more about the Alliance for a Healthy Kansas can go to its website: ExpandKanCare.com.

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