Kansas Gov. Sam Brownback didn’t specifically mention Medicaid expansion in his State of the State speech Tuesday night to a joint session of the Legislature.
But he made it clear that he remains opposed to expanding eligibility to cover more than 150,000 low-income adults, many of whom are uninsured.
Seeming to acknowledge that the closure of Mercy Hospital in the southeast Kansas community of Independence had increased support for expansion, Brownback said “Obamacare” was the main reason for its financial struggles and those of other rural hospitals.
“It was Obamacare that cut Medicare reimbursements to rural hospitals,” Brownback said, referring to the Affordable Care Act. “It was Obamacare that caused the problem. We should not expand Obamacare to solve the problem.”
Nationally, hospitals supported the ACA and the Medicare reimbursement reductions it included because they expected that increasing the number of Americans with private insurance and expanding Medicaid would more than offset those reductions. Kansas’ rejection of Medicaid expansion has denied hospitals and other health care providers in the state that offsetting revenue.
Not expanding Medicaid has cost Kansas providers $920 million and counting, according to the Kansas Hospital Association, which keeps a running total of the cost on its website.
Insisting that Medicaid expansion isn’t the solution to the struggles of rural providers, Brownback said he’s open to other proposals. He announced the creation of a working group to “address the problems of health care delivery in rural Kansas.”
Brownback named Lt. Gov. Jeff Colyer, a plastic surgeon and the primary architect of KanCare, the state’s privatized Medicaid program, to lead the group in crafting a plan for his consideration “by this time next year.”
“I believe this working group should have frontline stakeholders involved, including a rural hospital administrator and a rural physician, at the same time as top policymakers,” Brownback said.
Brownback said the working group would welcome input from “diverse organizations,” including the hospital association and others that support Medicaid expansion.
But referring to an ACA repeal bill that Congress passed but which President Obama vetoed last week, Brownback said it would be unrealistic to rely on “yet another false Obamacare promise.”
“We can and should find a Kansas solution that will improve rural health care access and outcomes,” he said.
Kansas is one of 19 states that haven’t expanded Medicaid eligibility.
Shortly before the governor’s speech, the hospital association distributed an editorial to Kansas media written by Terry Deschaine, a former hospital CEO and current member of the board of trustees at Sumner Regional Medical Center in Wellington.
Deschaine countered the governor’s arguments against expansion, saying it would “inject some much-needed cash into rural hospitals like Wellington’s.”
“As a former hospital administrator and current hospital board member, I implore our state leaders and lawmakers to expand KanCare,” Deschaine wrote. “While not a silver bullet, expanding KanCare is an important part of preserving access to hospital care across Kansas — and particularly in rural communities like Wellington.”
A recent report commissioned by the Sunflower Foundation and released by several Kansas health foundations said Medicaid expansion would lower state spending in several areas by enough to cover the annual $53 million cost of expansion, perhaps with money to spare.
The hospital association is working on an expansion bill modeled on so-called red-state plans adopted in other states headed by Republican governors. Association officials say they hope to have the bill introduced by next week.
Jim McLean is executive editor of KHI News Service in Topeka, a partner in the Heartland Health Monitor team.
