Kansas U.S. Sen. Pat Roberts is not enthusiastic about the Senate’s version of the Obamacare replacement bill.
Nevertheless, he supports it.
“This is not the best possible bill, it’s the best bill possible under very difficult circumstances. So, you don’t have any other alternative, I don’t think,” Roberts told reporters minutes after leaving a Thursday morning meeting where the bill, which was drafted in relative secrecy, was explained to Republican senators.
Roberts said even though he has concerns about the bill, “we have to move the process forward.”
“What’s the other alternative? I don’t see anything from the other side except single-payer, and that’s socialized medicine,” he said.
A bipartisan plan to fix the problems that are destabilizing the Affordable Care Act marketplace would be a better option, said David Jordan, director of the Alliance for a Healthy Kansas, a health care advocacy group formed by several Kansas health foundations.
“This bill is bad for Kansas,” Jordan said.
Fewer Kansans will qualify for help purchasing private insurance, he said, and those still able to purchase coverage in the subsidized marketplace will see higher out-of-pocket costs.
That’s because the bill would change how the federal tax credits are set. Under the Affordable Care Act, the credits are based on the cost of the second-lowest cost “silver” marketplace plan, which is supposed to cover about 70 percent of a household’s medical costs. The benchmark plan under the Senate bill would cover about 58 percent of a typical household’s medical costs.
The proposed change would leave people with two basic options: buy the lower-value plan to avoid paying a larger share of their premiums, or pay more in premiums to keep a higher-value plan and avoid higher deductibles.
Bob St. Peter, president and CEO of the Kansas Health Institute, said healthy individuals might benefit from pegging the subsidies to an insurance plan with lower premiums. Pushing customers toward plans with richer benefits may have priced some out of the market, he said.
“For the few people that need a high level of care, they’re going to have problems,” he said. “It sort of is, do you want fewer people with a very high level of coverage, or do you want more people with low-level coverage?”
Jordan said the approximately 440,000 Kansans enrolled in KanCare, the state’s privatized Medicaid program, should be the most concerned. He noted that the Senate bill calls for cuts deeper than the $880 billion over 10 years proposed in the House version.
Kansas’ share of those cuts would exceed $1 billion, according to an Urban Institute analysis.
“The people who are going to bear the brunt of the cuts in services are children, people with disabilities and seniors in nursing homes and rural health care providers,” Jordan said.
Jordan questioned how Roberts could support a bill that so closely resembles a measure passed in May by the U.S. House that both he and Kansas’ other senator, Republican Jerry Moran, criticized.
“The Senate didn’t even try to put lipstick on the pig, they made the House bill worse,” Jordan said. “It’s going to be tough for Senator Roberts and Senator Moran to square how they can support a bill that makes deeper cuts to Medicaid than the House bill and puts rural hospitals at even greater risk.”
The Kansas Hospital Association was the driving force behind a failed effort in the recent legislative session to expand Medicaid eligibility in part to help stabilize approximately 30 financially struggling hospitals across the state.
Across the country, 79 rural hospitals have closed since 2010 and 700 more are at risk of closing, according to a report aired Thursday on National Public Radio.
The Senate bill would end federal funding for Medicaid expansion but more slowly than proposed in the House measure. It would prohibit Kansas and other states still considering expansion from moving forward.
Kansas disability advocates joined counterparts from across the country in denouncing the Senate bill, charging that cuts in Medicaid would force states to reduce support services that help people with physical and developmental disabilities remain in their communities.
“To say that people will die under this law is not an exaggeration,” said Mike Oxford, a Kansas disability rights advocate. “Home and community-based services are what allow us to do our jobs, live our lives and raise our families.”
At a rowdy Lenexa town hall meeting earlier this month, Moran said he wasn’t happy with the secretive process used to craft the health care bill but said he wanted to study it before taking a position.
“I want to see what the health care bill is. I wish it was being addressed in a different way than it is, but let’s see what the outcome is,” Moran said.
He issued a statement Thursday afternoon that said he was “awaiting the Congressional Budget Office score to gain a complete understanding of the impacts and consequences this bill would have on hardworking Kansans. If this bill isn’t good for Kansas, it isn’t good for me.”
Medicaid spending changes
The Senate bill gives states the option of receiving a per-person amount for Medicaid participants or a block grant, St. Peter said. Either option would limit the federal government’s contribution, pushing the states to either cut their Medicaid spending or pay a larger portion themselves, he said.
“It clearly puts the states at a greater risk of cost overruns,” St. Peter said.
Political watchers can expect a battle in the Senate about how to structure a proposed block grant, St. Peter said. Certain structures could penalize states like Kansas that have kept their Medicaid costs lower, he said.
Currently, the federal government pays a set percentage of Medicaid costs that increases as spending grows. If the bill passes, it would increase spending based not on states’ actual costs but on a measure of inflation — the consumer price index.
According to Bureau of Labor Statistics, the medical portion of the consumer price index includes prescription drugs, medical supplies, physicians’ services, eye care and hospital services. That measure showed the cost of medical care growing between 2.4 percent and 4.4 percent annually since 2007.
In Kansas, spending on Medicaid grew by an average of 4.5 percent per year from 2007 to 2010, and 3.2 percent per year from 2010 to 2014. If the federal Medicaid spending growth rate had been tied to the consumer price index during that time, Kansas would have had to reduce its spending or increase its contribution in multiple years.
Jim McLean and Meg Wingerter are reporters for the Kansas News Service, a collaboration of KCUR, Kansas Public Radio and KMUW covering health, education and politics. Kansas News Service stories and photos may be republished at no cost with proper attribution and a link back to kcur.org.