If the Kansas Health Policy Authority has its way – and there’s a fair chance it will – you’ll soon be hearing more about staying healthy, less about health care.

“That is our mandate,” said Marcia Nielsen, the authority’s interim executive director.

The change marks a huge, though little publicized, shift in the state’s debate over how to care for the uninsured while keeping a lid on health care costs.

“About 95 percent of all the dollars spent on health today are, in fact, spent on health care services,” Nielsen said, though there’s little evidence that Kansans are enjoying better health.

“There’s a disconnect,” she said.

Lawmakers have given the Health Policy Authority until Jan. 1, 2007, to come up with a plan for putting healthy living on an equal footing with health care. The panel’s first regular monthly meeting is Tuesday.

Nielsen said she expects the plan to include incentives to get people to quit smoking, lose weight and adopt healthier lifestyles.

“Absolutely, we need carrots and sticks,” Nielsen said.

The possibilities include:

¢ Lower insurance premiums for state employees who don’t smoke, who are not overweight and who undergo health assessments.

¢ Co-pays for Medicaid recipients who smoke or are overweight.

¢ Advertising campaigns aimed at promoting good health.

¢ Requiring motorcyclists to wear helmets.

“We’ve not talked about (helmets),” Nielsen said. “But nothing is off the table when it comes to promoting health and wellness.”

This isn’t idle talk. Earlier this month, the Health Policy Authority took over most of the state’s Medicaid programs – payments to doctors, hospitals and pharmacies, mostly – and its insurance programs for state employees and uninsured children.

Combined, the three programs cover almost 400,000 Kansans and $2.4 billion in spending.

“This is huge,” said Dr. Robert St. Peter, CEO at the Kansas Health Institute, a Topeka-based health policy think tank. “Certainly, this is one of the largest reorganizations in state government in the last 25 years. It’s a fundamental shift in the administration of what amounts to 20 percent of the state’s budget.”

Though the Health Policy Authority’s nine members are appointed by lawmakers – three by the governor, six by the Legislature – the group has considerable autonomy.

“This is a group that doesn’t have to worry about getting re-elected,” St. Peter said. “It can make the tough, hot-potato decisions so that legislators and the governor don’t have to.”

The arrangement is unique.

“I feel confident in saying there are no others states with a setup like this,” St. Peter said.

That’s fine with Rep. Brenda Landwehr, a Wichita Republican and chairwoman of the budget committee that oversees Medicaid spending.

“I want them to step outside the box. I want them to do what’s best for the people of Kansas – not what’s best for politicians,” Landwehr said.

It won’t be easy.

“The pressure to focus on Medicaid policy – rather than health promotion and prevention – is going to be enormous simply because it’s such a large part of the budget,” St. Peter said.

Other hurdles to the authority’s aspired control over all health-related programs and policies include:

¢ Whether the state Department of Health and Environment will give up its role setting health policy remains to be seen.

¢ Medicaid-funded programs for the physically and mentally disabled remain at the Department of Social and Rehabilitation Services. Those for the aged remain at the Department on Aging.

Meanwhile, promoting better health isn’t expected to reduce health care costs anytime soon, which likely will result in political pressure to cut or limit spending.

“I’m in total agreement that we’re dealing with a system that’s more sickness-based than health-based,” said Paul Johnson, a longtime advocate for the state’s poor and low-income families.

“But you can’t take from today to get to tomorrow,” he said. “At some point, there’s going to have to be double-funding. I hope I’m wrong, but I have a hard time seeing the Legislature go along with that.”

Measuring the authority’s success, too, will be difficult.

“If you exercise, watch what you eat and take your vitamins, how do you know if you prevented a heart attack?” said Nikki King, director at Health Care Access, a Lawrence clinic for the uninsured. “That’s the problem – you don’t know.”

Still, King said she welcomed the shift in priorities.

“I’m all for changing paradigms,” she said. “The way it is now, there really isn’t a high value put on health education and preventative care. Everybody just wants a pill that fixes everything.”