Topeka A state agency's long-awaited health care plan would cost $160 million during its first year and rely heavily on higher tobacco taxes to pay for it, legislators learned Thursday.
The biggest cost would be an expansion of subsidies to help poor families buy private health insurance. Also, the state would provide coverage to more children and increase its payments to doctors, hospitals and clinics for their services.
The Kansas Health Policy Authority's 21 recommendations also include less expensive and no-cost proposals designed to help Kansans improve their health and emphasize preventive care. Its plan includes a statewide ban on smoking in public places.
The authority outlined its proposals during a meeting of the Legislature's Joint Committee on Health Policy Oversight. The authority has discussed its recommendations for weeks, but the meeting was the first time it disclosed the total cost of its initiatives for fiscal year beginning July 1, 2008.
Higher tobacco taxes would raise nearly $52 million, and the plan would rely on nearly $74 million in federal funds. The state would have to find an additional $34 million and the authority said possibilities could include special "lifestyle" taxes on items such as soda or junk food.
"We do strongly believe that we need federal leadership on these issues, but states clearly have taken the responsibility to do the things that they can," said Marcia Nielsen, the authority's executive director.
Public health officials have long advocated higher tobacco taxes and a statewide smoking ban, but both ideas have encountered strong opposition among legislators.
The authority has proposed an increase in the cigarette tax of 50 cents a pack, to $1.29, and legislators ignored the same proposal from Gov. Kathleen Sebelius in 2005. Legislation creating a statewide smoking ban stalled this year after it was amended to allow county officials to opt out.
Still, Sen. Jim Barnett, the committee's chairman and a physician, told Nielsen he would have been disappointed if the authority hadn't shown "intestinal fortitude" and recommended the antitobacco proposals.
"Thank you for doing this," said Barnett, an Emporia Republican. "I know you're going to take fire from both left and right for what you've done so far."
The health authority believes its plan will provide coverage to 86,000 of the state's 300,000 uninsured residents. The figure includes 20,000 children who are eligible but not enrolled for state health coverage.
But Nielsen noted that most of the authority's recommendations deal with improving Kansans' health and getting doctors, hospitals and clinics to emphasize preventive care. The authority recommends strengthening schools' physical education programs, having schools track student obesity rates and having the state pay for cancer screenings for poor Kansans.
"You will see that these 21 recommendations extend to a far broader set of policy options than merely insurance or medical care," Nielsen said. "We made those decisions quite deliberately."
Some legislators questioned the authority's tactic of proposing so many ideas. Committee members repeatedly asked Nielsen to list a few, high priorities. She couldn't, reflecting the authority's inability in its discussions to narrow its list.
"I'd hoped they would set a clear direction for us to move, as opposed to presenting a box full of ideas and saying, 'Here, pick and choose as you see fit,' " said House Minority Leader Dennis McKinney, a Greensburg Democrat. "I don't mind having 21 ideas presented. I would like for them to have isolated three to five high-priority items."
Expanding insurance subsidies for poor Kansans would cost $119 million during the next fiscal year. Legislators approved the program earlier this year, and it would provide an average subsidy of $3,200 a year.
But the aid wouldn't start until 2009, and it would be four years before it would be available to all Kansans whose household incomes are at or below the federal poverty level, or $20,650 for a family of four.
The authority's plan would make subsidies available to those Kansans in fiscal year 2009, at an additional cost of $119 million.