Medicaid

Executive Office of the President of the United States

Advocates of government-sponsored health care gathered Thursday at the Harry S. Truman Library and Museum in Independence, Missouri, to mark the anniversary of legislation that’s both a local story and a milestone for medical care in the United States.

Fifty years ago, on the same stage where speakers sat, President Lyndon Johnson signed the law establishing Medicare and Medicaid, vastly expanding insurance protections for the elderly and for low-income Americans.

Andy Marso / Heartland Health Monitor

Gov. Sam Brownback said Friday he’s unconvinced Medicaid expansion is an answer to the financial woes of rural Kansas hospitals and suggested they should innovate instead.

During a news conference Friday, Brownback was asked about a Reuters story on the improving financial fortunes of public hospitals in states that expanded Medicaid under the federal Affordable Care Act versus the stagnation of hospitals in states that did not.

Jim McLean / Heartland Health Monitor

Editor's note: This is the second of two stories looking at Medicaid expansion in Missouri and Kansas. Today's story looks at the failure to expand Medicaid in Kansas. Wednesdays story looked at the failure to expand Medicaid in Missouri. Tonight, Thursday, at 7:25 p.m., KCPT Channel 19 will air a video tied to the stories. 

  The Kansas Hospital Association and other groups urging Kansas lawmakers and Kansas Governor Sam Brownback to expand Medicaid coverage to more poor adults have little to show for their three years of lobbying on the issue.

Truman Medical Centers

Editor's note: This is the first of two stories looking at Medicaid expansion in Missouri and Kansas. Today's story looks at the failure to expand Medicaid in Missouri. Tomorrow's story will look at the failure to expand Medicaid in Kansas. On Thursday at 7:25 p.m., KCPT Channel 19 will air a video tied to the stories. 

It’s a sweltering Monday afternoon, and in the emergency room of Truman Medical Centers near downtown Kansas City, a patient complains of excruciating abdominal pain.

The attending physician advises her there’s only so much he can do.

Andy Marso / Heartland Health Monitor

One of the leading advocates for Medicaid expansion in Kansas says it’s time to change tactics.

This week Alaska became the 30th state to expand Medicaid under the federal Affordable Care Act. Kansas is one of the remaining states where Republican legislators and governors remain resistant.

Mike Sherry / Heartland Health Monitor

Advocates for expanding Medicaid coverage to more low-income Americans must refine their strategies to win over lawmakers in states such as Missouri and Kansas, which have resisted efforts to loosen eligibility requirements.

That was the message Saturday during a panel discussion at the National Council of La Raza annual conference, which is being held at the Kansas City Convention Center.

“I would say it is going to take more than what we have been doing,” said Laura Guerra-Cardus, associate director of the Children’s Defense Fund in Texas.

Financial disclosures aren’t just for political candidates. New data released by the Centers for Medicare and Medicaid Services shows that Missouri doctors received at least $71.9 million from medical device and drug companies in 2014 and the latter half of 2013. Illinois doctors pulled in $104 million during that same time period, many of whom hail from the Chicago area.  

Bryan Thompson / Heartland Health Monitor

A lot of the hospitals in rural Kansas are called “Critical Access Hospitals.” It’s an important designation, because Critical Access Hospitals were created by the federal government to maintain access to health care in rural areas.

But Many Kansas Critical Access Hospitals are in financial trouble. Medicare requires them to offer 24-hour emergency services. But most don’t have enough ER patients to justify the cost of 24-7 service, says Melissa Hungerford, senior vice president for health care leadership at the Kansas Hospital Association.

The Kansas Health Consumer Coalition will cease operations this week.

“It’s been a struggle to maintain our funding,” said Carol Ramirez Albott, president of the Topeka-based advocacy group’s governing board. “Things just got to a point where we felt like we couldn’t adequately do the job.”

The board, she said, notified its supporters of the decision late last week.

Attorneys general in 10 states, including Kansas, have asked a congressional committee to investigate efforts by the Obama administration to “coerce” states to expand their Medicaid programs by withholding unrelated healthcare funds.

Jim McLean / Heartland Health Monitor

Legislators locked in increasingly tense discussions about how to balance the budget and end the longest legislative session in Kansas history said there is no longer any serious talk about expanding Medicaid eligibility this year.

“Given all the time we’ve wasted, it is incredibly disappointing that we couldn’t find the time to deal with this issue,” said Rep. Jim Ward, a Wichita Democrat and the Legislature’s most vocal advocate of expansion.

Kansas Governor Sam Brownback’s determination to not expand Medicaid in his state remains strong. On this edition of Up To Date, journalist Kai Wright discusses his recent article for The Nation, which examines the effects the governor's policy on Kansas residents and medical professionals. 

Andy Marso / Heartland Health Monitor

Frustrated by their inability to muster more than a handful of votes for any tax plan, Kansas Republican legislative leaders are asking rank-and-file members the “What will it take to get out of here?” question.

They’re getting a variety of answers as the session, on its 103rd day, inches closer to record territory as the longest in state history. In 2002, legislators met for 107 days.

A Senate committee on Thursday learned that a bill proposing that the state collect a 3.5 percent fee on health insurance policies sold to Kansans on the federal government’s online marketplace could be used to force a vote on Medicaid expansion.

“I want to know if Senate Bill 309 could be a vehicle for Medicaid expansion,” Sen. Laura Kelly, a Topeka Democrat, asked in the final minutes of the Senate Ways and Means Committee hearing.

KHI News Service photo

Some legislators are considering the possibility of eliminating the state’s earned income tax credit in exchange for expanding its Medicaid program.

“That’s being shopped around, big time,” said Sen. Laura Kelly, a Topeka Democrat.

“There’s been discussion of that, yes,” said Rep. Don Hill, an Emporia Republican.

Kelly and Hill, who serve on their respective chambers’ health and budget committees, declined to say which legislators are promoting the would-be deal.

Mercy Hospital, Independence

At the beginning of the 2015 legislative session, Kansas hospital administrators signaled their willingness to talk about increasing a state assessment on their revenues to fund Medicaid expansion.

They anticipated that the state’s deteriorating budget situation would make it impossible for Gov. Sam Brownback and Republican legislative leaders to consider expansion without a way to pay for the state’s share of the costs.

And they anticipated that even with funding options, Medicaid expansion was a long shot to pass.

Supporters say they still hope to force floor votes on an expansion bill, although Brownback and legislative leaders remain opposed to it.

But it’s clear that hospital officials didn’t anticipate the turn of events that has put them on the defensive in the final weeks of the session.

Brownback and key lawmakers are now talking about raising the provider assessment. But they see it as a way to help balance the budget rather than fund a Medicaid expansion plan.

 

Gov. Sam Brownback on Monday announced that Kansas would file a brief supporting Florida Gov. Rick Scott’s lawsuit against the federal government over Medicaid expansion.

The Center for Medicare and Medicaid Services recently warned Florida, Kansas and Texas that failing to expand Medicaid under the Affordable Care Act could jeopardize special funding to pay hospitals and doctors for treating the poor.

Bryan Thompson / Heartland Health Monitor

There are a lot of small, rural hospitals in Kansas. Without them, many Kansans would have to travel long distances for care. What’s more, in many small towns, the hospital is one of the largest employers — making it vital to the local economy.

But declining populations, combined with changes in the way hospitals are paid for their services, are making it more difficult for many small hospitals to survive.

There is at least one hospital in 96 of the state’s 105 counties, according to Melissa Hungerford, senior vice president for health care leadership at the Kansas Hospital Association and chief executive officer of the Kansas Hospital Education and Research Foundation.

The stakes for Kansas to expand Medicaid have been raised.

The state received notice from the Centers for Medicare and Medicaid Services last week that if it doesn’t expand its Medicaid program, it would lose federal funding for uncompensated health care, according to officials from the Kansas Department of Health and Environment.

The federal government provides money for the state’s uncompensated care pool to reimburse health care providers who serve the uninsured.

AP Photo

The public should expect to see significant evolutions in Medicare and Medicaid in coming years, a national health care expert told a Kansas City audience Friday.

Genevieve M. Kenney of the Urban Institute said an inevitable component of Medicare’s need to save money will be talk about raising the eligibility age. The current age of eligibility is 65, but life expectancy has increased since enactment of the program 50 years ago.

Chris Potter / StockMonkeys.com

Missouri claimed nearly $35 million in unallowable Medicaid reimbursements after failing to comply with requirements under Medicaid’s drug rebate program, an audit released Tuesday found.

All 50 states and the District of Columbia cover prescription drugs under the program, which helps offset the costs of outpatient prescription drugs for Medicaid patients.

A conference committee agreed Wednesday to adopt a budget bill that cuts $378,000 from a grant program that supports safety net clinics throughout Kansas.

“We’re greatly disappointed,” said Denise Cyzman, executive director of the Kansas Association for the Medically Underserved, an organization that represents the 43 safety net clinics in Kansas.

A conservative advocacy group that opposes Medicaid expansion in Kansas is fighting a Florida plan backed by that state’s Republican Senate president.

Health News Florida, a partner of the KHI News Service, reports that Americans for Prosperity, a free-market advocacy group funded by Kansas business titans Charles and David Koch, is sending mailers to voters in 23 Florida Senate districts in an effort to stop a Medicaid expansion plan that recently started gaining momentum.

Mercy Hospital Independence

Two southeast Kansas hospitals — one in Independence, the other in Fort Scott — are among several in Kansas that might have to close in part due to the state’s failure to expand Medicaid.  

To prevent that, both are actively negotiating potential partnerships with neighboring hospitals. Officials at Mercy Hospital Independence and the Coffeyville Regional Medical Center are talking. Similar discussions are underway between Mercy Hospital Fort Scott and Via Christi in Pittsburg.

Jim McLean / Heartland Health Monitor

The recent legislative hearings on Medicaid expansion brought representatives from dozens of powerful groups to the Kansas Statehouse.

Lobbyists representing hospitals, doctors and some big businesses pleaded with members of the House Health and Human Services Committee to approve an expansion proposal one day.  The next day representatives of conservative, anti-tax organizations urged committee members to continue to say ‘no’ to expansion, despite the billions of additional federal dollars it would inject into the Kansas economy.

But the hearings also attracted scores of everyday citizens. They included those who need the coverage that expansion would provide and others opposed to extending benefits to non-disabled adults.

Andy Marso / Heartland Health Monitor

Kansas officials told legislators Thursday that the state's share of Medicaid expansion costs could start at $100 million per year and increase from there, and those costs could double if the federal government required full funding of waiting lists as a condition of expansion.

One day after her predecessor testified in favor of expansion under the Affordable Care Act, Kansas Department of Health and Environment Secretary Susan Mosier provided neutral testimony that warned legislators of potential fiscal pitfalls.

Dave Ranney / Heartland Health Monitor

Robert Moser, who until December was the secretary of the Kansas Department of Health and Environment, headlined a long list of Kansans asking legislators Wednesday to expand Medicaid.

Andy Marso / Heartland Health Monitor

Supporters of expanding Medicaid in Kansas are finally getting an opportunity to make their case to lawmakers.

Republican legislative leaders opposed to expansion have blocked hearings on the issue for two years. They agreed to allow hearings this year only after supporters in the Kansas House threatened to force an immediate vote on the floor.

Elle Moxley / KCUR

In Indiana, low-income people can open health savings accounts.

Utah lawmakers are building work participation and co-pays into their Medicaid overhaul.

Iowa will charge a monthly premium – and crack down on the costly practice of using emergency rooms for non-emergency care.

But as other deep-red states agree to expand Medicaid within their borders, Gov. Jay Nixon says Missouri is leaving federal health care dollars on the table.

Alex Smith / Heartland Health Monitor

In the pediatric clinic at Samuel U. Rodgers Health Center, nurse Constance Grayson gives newborn-care instructions to a jittery-looking young couple.

Samuel U. Rodgers is one of Kansas City’s largest safety net health clinics, and the doctors and nurses here take pride in offering care to all. That means learning to expect the unexpected.

But cuts in funding are something else, according to CEO Hilda Fuentes, who  recently got a letter explaining that the money she gets from the city would be cut this fiscal year by more than 10 percent, or about $167,000.

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