Colyer poised to become governor during key time in health care debate

July 27--TOPEKA -- Lt. Gov. Jeff Colyer, a plastic surgeon, may become governor at a key moment in a raging national debate over health care.

The path Colyer forges on health policy in Kansas would carry consequences for hundreds of thousands of Kansans -- and help determine his political fortunes. It could well define his time as governor.

Colyer faces a new spotlight after President Donald Trump nominated Gov. Sam Brownback on Wednesday to take a diplomatic post. If the U.S. Senate confirms him, he will resign and Colyer will become governor.

The transition would likely happen at a delicate time for health care in Kansas.

The state must receive permission from the federal government before the end of the year to continue its privatized Medicaid program, called KanCare. That's not entirely a sure thing after federal officials denied an earlier request to keep the program going, starting the ticking clock.

At the same time, Congress is in the middle of an epic battle over health care and substantial changes to Medicaid are in the mix. Or lawmakers may gridlock and change nothing.

If Congress leaves Medicaid expansion in place, supporters are likely to continue pushing Kansas to expand eligibility for the program. Colyer has been adamantly opposed to expansion.

The fate of KanCare matters because it is the program that helps cover low-income adults, pregnant women and people with disabilities. It helps the elderly pay for nursing homes. Cuts or changes could personally affect the state's 500,000 enrollees.

But it also affects Kansas financially. The state spent at least $1.4 billion on Medicaid last year. The program accounts for more than 20 percent of the state's budget, which has often been under pressure during the past few years.

Colyer helped spearhead the creation of KanCare in 2013 as lieutenant governor. The effort brought to bear both his medical and political experience.

For the 57-year-old, it is arguably his biggest legacy as lieutenant governor, and would likely be a large issue in a gubernatorial campaign.

"I've had a big influence on a lot of major decisions," Colyer said about his role in the administration. "It hasn't been you're just waiting around twiddling your thumbs."

KanCare's record

KanCare is a clear success, according to Colyer. He spoke approvingly in a speech to the National Lieutenant Governors Association in Nashville on Wednesday just hours before Brownback's nomination was announced.

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"In the end, whatever happens in D.C., I suspect that most of your states will look more like KanCare, and what we're doing in the state of Kansas, five years from now in a lot of ways," Colyer said.

Under KanCare, the state contracts with insurance companies to administer the state's Medicaid program. The companies are called managed care organizations, or MCOs.

The Brownback administration says Kansas has saved $1.4 billion since KanCare was implemented, based on 2012 costs projections. Cost increases have been less than projected, it says.

Still, Medicaid spending has been rising faster since KanCare was enacted. In the first two full years of KanCare, spending grew by nearly $500 million. It took more than three years for spending to grow by the same amount in the years immediately before KanCare.

Critics say the program has been rife with problems. Federal officials last year found issues with the administration of the program, including in sufficient oversight, and in January denied Kansas' request for a one-year extension of the program while it developed a proposal for a long-term reauthorization.

"The ongoing problems we encounter with the state and the MCOs make our lives more difficult. For those of us in the field, for so many years, we are worn out and discouraged," Marilyn Kubler, director of Jenian Inc., a case management firm, told lawmakers in April.

"The assurances given by politicians and insurance companies have worn thin. We would like to see the state live up to what they promised us when they implemented KanCare."

New health providers are hesitant to enroll in KanCare, she said, because of low pay and "mountains of paperwork." Problems with billing have continued, she said.

Currently, the federal authorization for KanCare will expire on December 31. But lawmakers and officials have expressed confidence that Kansas would find the Trump administration more receptive to KanCare.

Kansas still has to re-apply, however, and that hasn't happened yet. KanCare spokeswoman Angela de Rocha said Wednesday the state will apply in August.

Better Relationships

Rep. Dan Hawkins, R-Wichita, chairs the House health committee. He said he's looking forward to Colyer's focus on health issues. And he suggested Colyer will have a good relationship with lawmakers.

"He knows what we go through on a yearly basis when we come into session and I think he will be a whole lot more in tune with what the will of the House is," Hawkins said.

Colyer served in the state House and Senate before becoming lieutenant governor.

Sen. Rob Olson, an Olathe Republican who sat next to Colyer in the House, said that "a lot of times he would leave on a Friday and fly somewhere and do free surgeries and then come back."

Olson expects Colyer to distinguish himself from Brownback in the coming months.

"A lot of people are going to wonder what kind of governor he'll be, if he'll be the same as Brownback, or if he'll be different," Olson said. "... He's been in the shadow of Brownback, and I think he will do some things different and I think he'll probably surprise some people."

Although lawmakers have said Colyer might get along better with the Legislature than Brownback -- who faced heightened tensions with lawmakers this year -- it's unknown how a fight over Medicaid expansion would test relationships.

Sen. Laura Kelly, D-Topeka, sits on the Senate Public Health and Welfare Committee. She suggested Colyer could be seen as a lame duck, given the governor's race in 2018.

"I don't think he has enough time to do much damage," Kelly said.

Lawmakers voted this spring to expand eligibility in the program, but Brownback vetoed the measure. Supporters were unable to muster enough votes to override.

"I hope that he has a goal and a desire to work with the Legislature to find the common ground that the people of Kansas want," said Sen. Carolyn McGinn, R-Sedgwick. "They want a good economy. They want jobs that produce prosperity for everyone. And we have to find that mix that works well for all."

Election Prospects

Colyer will only be around for one legislative session, unless he runs for election and wins next year. He has not said yet whether he will run.

Patrick Miller, a political scientist at the University of Kansas, said Colyer is "not a very known quantity to most people, in terms of who he is, what his brand is, what he stands for."

With a number of Republican candidates already in the race, winning the GOP nomination wouldn't be assured. Colyer would also have to decide how to approach his ties to Brownback, who has among the lowest approval rating of any governor in the country.

"Since lieutenant governors are virtually unknown by the voting public, Colyer's opponents would be politically remiss not to remind voters of the 'Colyer/Brownback team' over and over and over," said Bob Beatty, a political scientist at Washburn University.

Colyer was also the subject of a federal grand jury investigation into a series of $500,000 loans he made to Brownback's re-election campaign in 2014. No charges were filed.

"It was all speculation," Colyer said in December when asked about the investigation. "That's a period of history that's over."

The issue could resurface in a gubernatorial campaign. Secretary of State Kris Kobach is running, and has slammed what he calls a "culture of corruption" in Topeka.

If Colyer is able to vanquish Kobach, Beatty predicts he could win the general election by turning to the same playbook used by past conservative Republicans: branding Democratic opponents as too liberal.

The big question, Beatty said, is whether the strategy can work again in a state that sees Brownback so negatively.

"The Brownback shadow will circle Colyer like an albatross over a man adrift at sea," Beatty said.

Contributing: Daniel Salazar of The Eagle and Bryan Lowry and Hunter Woodall of the Kansas City Star

Jonathan Shorman: 785-296-3006, @jonshorman

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