Thursday, January 9, 2014

Kansas hospitals leading new push for Medicaid expansion

By JIM McCLEAN, KHI News Service

TOPEKA — Many uninsured Kansans who Congress assumed would get coverage under the health reform law are instead falling in to what is being called the “Medicaid gap.”

They make too much money or don’t meet other criteria to qualify for the state’s Medicaid program – called KanCare – but don’t earn enough to be eligible for federal tax credits to offset the cost of private insurance.

Those credits are available only to people with incomes between 100 percent and 400 percent of federal poverty guidelines. The federal poverty level is $11,490 a year for an individual and $19,530 for a family of three.

As many as an estimated 85,000 uninsured Kansans fall in the eligibility gap, according to researchers at the Kansas Health Institute, a nonprofit policy and research organization that includes the editorially independent KHI News Service.

These Kansans have incomes that are 33 percent or more of the federal poverty threshold — $6,445 for a family of three — but below 100 percent of poverty guidelines.

Katelyn Winrick, a 26-year-old nursing student from Topeka, recently discovered she falls in the gap.

She had come to the Topeka Shawnee County Public Library to get help purchasing health insurance on But after entering information about the income she earns from a part-time job, Winrick and the navigator assisting her concluded she didn’t make enough to qualify for a federal tax credit. That and the fact that she would have been eligible for Medicaid if Kansas officials had opted to expand the program as originally intended by the authors of the Affordable Care Act were “real eye openers,” Winrick said.

“I’m going to school and that really would have helped me given my income situation,” she said.

‘The only priority’

The Affordable Care Act, as signed into law in 2010, was written to include a nationwide expansion of Medicaid to cover everyone earning up to 133 percent of the federal poverty level — $15,282 for an individual and $25,975 for a family of three. But the 2012 U.S. Supreme Court decision that upheld the law held that Medicaid expansion was an option for each state to decide. Policy makers in Kansas and 23 other Republican dominated states so far have chosen against expansion.

The Kansas Hospital Association and a growing coalition of more than 50 organizations are preparing to push Gov. Sam Brownback and leaders in the Republican-controlled Legislature to change their minds and broaden the program.

“It is the only priority,” said Sean Gatewood, the interim director of the Kansas Medicaid Access Coalition. “All we care about is getting the state to accept the money and to cover more Kansans.”

An analysis done for the hospital association concluded that expanding Medicaid eligibility starting this year would have injected another $3 billion into the state economy and create 4,000 jobs by 2020.

Rejecting expansion will cost Kansas an estimated $5.3 billion in federal aid between 2013 and 2022, according to a report released last summer by the Kaiser Family Foundation.

In an effort to get the issue of expansion back in front of legislators, the hospital association has hired Mike Leavitt, former secretary of the U.S. Department of Health and Human Services, to help it craft an alternative plan — perhaps similar to those being advanced by Republican governors in Iowa, Pennsylvania, Tennessee and Michigan, which would use federal Medicaid dollars to help low-income people buy private coverage.

“We ought to as a state be having a conversation about whether we can come up with a plan like that and the reality is that conversation just hasn’t happened yet,” said Tom Bell, the hospital association’s chief executive.

Bell said he hopes that Leavitt, a Republican who served under President George W. Bush’s and is a former Utah governor, can help convince Kansas Republicans to seriously consider Medicaid expansion options.

“My sense is that he (Leavitt) is somebody that’s not a big fan of the Affordable Care Act or Obamacare, but he also knows that whether we like it or not we’re all in the implementation business right now,” Bell said.

Rep. Jim Ward, a Wichita Democrat, who pushed unsuccessfully last year for Medicaid expansion, said he welcomes the attempt to revive the policy debate by focusing on an approach that relies more on private-sector insurance.

“If that helps some of our more extreme conservative folks to support it, I’m OK with that,” Ward said. “I’m all for anything that gets us an opportunity to participate in Medicaid expansion.”

Time will tell whether the new approach will be the game changer Bell and others seek. 

Governor's leadership

Rep. Ron Ryckman Jr., a conservative Republican from Olathe and chairman of the House Social Services Budget Committee, said any sort of Medicaid expansion likely would be a tough sell unless Gov. Brownback changes his mind and decides to play an active role in the debate.

“I haven’t spent a lot of time researching what other states have done, but it seems to me that the governor has taken the lead in states that have expanded (Medicaid) or that are having these discussions,” Ryckman Jr. said.

Last year, Brownback did not explicitly rule out expansion. But he expressed reservations about the potential cost to the state and said it would be up to the Legislature. The Legislature subsequently passed a budget proviso saying the state could not expand its Medicaid program without explicit legislative support.

Brownback officials recently said they continue to study what other states are doing.

Bell said he was optimistic the governor eventually would support some form of expansion.

"From the very beginning, Gov. Brownback has been very interested in taking a hard look at this — and I think partly because of his concern for those who are less fortunate. I've heard him talk about that often, and I do think that it's a factor for him. There are lots of factors, I'm sure, but I think how we treat those who are the least fortunate among us is something that's important to the governor — very important to him."