Wednesday, March 27, 2013

Former Kansas officials may provide path for current leaders to Medicaid expansion

By SCOTT ROTHSCHILD, The Lawrence Journal-World

Two former Kansas officials — Kathleen Sebelius and Andy Allison — may be helping Kansas leaders find a way to expand Medicaid without appearing to embrace Obamacare.

"We're looking at everything," Gov. Sam Brownback, a vocal critic of the Affordable Care Act, signed into law by President Barack Obama.

"Arkansas just got approved on some interesting things that we are trying to analyze and understand," Brownback said Wednesday.

The U.S. Department of Health and Human Services, which is led by former Kansas governor Kathleen Sebelius, has given preliminary approval to Arkansas to use federal Medicaid expansion dollars to buy private coverage for low-income residents.

Arkansas' Medicaid director is Allison, who used to serve as director of the Kansas Health Policy Authority, which Brownback folded into the Kansas Department of Health and Environment.

The initiative by Arkansas and other Republican-dominated states has caught the eye of Senate President Susan Wagle, R-Wichita.

"There could be a Kansas-based solution that evolves," Wagle said.

The Affordable Care Act called for expansion of Medicaid to provide health care coverage for more low-income people. But the U.S. Supreme Court ruling that upheld the ACA also said that states have the option of expanding Medicaid.

In Kansas, the expansion would cover upwards of 200,000 people and would be paid for by the federal government for three years. Then the federal portion would decrease to 90 percent of the cost after that.

States run by Democrats have been opting for expansion, while states run by Republicans have either rejected the plan or are venturing in slowly. Brownback has said he is undecided at this point.

He has said repeatedly that he is concerned that the federal government will not keep up its end of the deal and more of the costs will fall on the state. Some Republican legislators have said Kansas shouldn't expand. The House Appropriations Committee approved a resolution that indicates the Legislature's "intention not to expand Medicaid services in Kansas," under the ACA.

But Wagle said she is concerned that states opting in to Medicaid expansion will benefit from Kansas tax dollars.

"Kansas is losing out and it does affect our health care industry and it does affect the quality of our services," she said.

By doing nothing, she said, Kansas has already "given away one year."

Just hours later, the Kansas Medicaid Access Coalition delivered petitions to Brownback urging him to accept the federal dollars to expand Medicaid.

Mari White, 51, of Topeka said she, her husband and two sons suffer significant health problems and are facing mounting medical bills while still unable to receive Medicaid assistance.

"All we need is a temporary boost," she said.

Jon Stewart, chief executive officer of the Heartland Community Health Center in Lawrence, described expanding Medicaid as "investing in prevention."

Currently, Medicaid provides health care coverage to about 380,000 Kansans. The largest portion of them — about 230,000 — are children. The rest are mostly lower-income, pregnant women, people with disabilities and elderly people. The $2.8 billion program is funded with federal and state dollars.

Medicaid in Kansas doesn’t cover low-income adults who don’t have children. And a nondisabled adult with children is eligible only if his or her income is below 32 percent of the poverty level, which is less than $6,000 per year. That is about the most difficult eligibility level in the country.

But starting in 2014, the ACA creates an eligibility level of 138 percent of the federal poverty level, which is $15,415 per year for an individual and $31,000 per year for a family of four.

"We are talking about helping people who are really struggling right now," said Anna Lambertson, executive director of the Kansas Health Consumer Coalition.

Wagle said while many of her constituents "don't trust Obamacare," the Legislature needs to remain flexible in considering its options.