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Archive for Saturday, December 29, 2012

In new year expect more dueling over health care

December 29, 2012

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— TOPEKA — Gov. Sam Brownback spent 2012 stiff-arming Obamacare, but received federal permission to turn over the Kansas Medicaid program to private companies.

That kind of maneuvering will likely continue in 2013 as more of the Affordable Care Act, commonly referred to as Obamacare, becomes a reality, the new Medicaid system, called KanCare, takes effect this week, and a major decision awaits on whether to expand Medicaid coverage to tens of thousands of Kansans.

“That, to me, is the big outstanding issue,” said Sheldon Weisgrau, director of the Health Reform Resource Project, which is funded by five Kansas health foundations. Whether Medicaid is expanded “will directly impact a number of people, how they access services, how many people will get sick and die in the state,” Weisgrau said.

At issue is whether Kansas should increase the income eligibility for Medicaid. Expanding Medicaid was a major provision of the Affordable Care Act aimed at getting more people under a health plan.

And while the U.S. Supreme Court ruled the ACA constitutional, the decision allowed states to decide whether to participate in the expansion. Several states, led by Democratic governors, have said they will expand, while several other states, led by Republican governors, have rejected the idea.

Currently, Medicaid in Kansas provides health care coverage to about 380,000 people, with the largest portion of them — about 230,000 — being children. The rest are mostly lower-income, pregnant women, people with disabilities and the elderly. The $2.8 billion program is funded with federal and state dollars.

Medicaid in Kansas doesn’t cover low-income adults who don’t have children. And a nondisabled adult with children is eligible only if his or her income is below 32 percent of the poverty level, which is approximately $5,000 per year. That is about the most difficult eligibility level in the country.

But starting in 2014, the ACA creates an eligibility level of 138 percent of the federal poverty level, which currently stands at $15,415 per year for an individual and $26,344 per year for a family of three.

Estimates indicate that Kansas’ Medicaid enrollment would increase by 135,000 people under the ACA expansion. In addition, health care experts say many more children would gain coverage as their parents sign up. Estimates show that about 70 percent of Kansas children currently without health insurance actually are eligible for Medicaid but are not enrolled.

If Kansas opts for the expansion, the federal government would pay for 100 percent of the additional cost for three years starting in 2014. Then the federal share would drop to 90 percent by 2020.

Several Republican governors have dismissed the expansion out of hand, but Brownback, also a Republican and ardent critic of the ACA, has said he wants to study the issue. He has expressed doubts that the federal government could afford the expansion in future years because of budget problems.

Weisgrau said policymakers should focus on what the law says now because future appropriations for anything done by the federal or state government are never guaranteed.

And while U.S. Census Bureau figures show Kansas’ uninsured population is below the national average, the state figure is going against the national trend.

The national uninsured rate decreased from 16.3 percent, or 49.9 million people in 2010 to 15.7 percent, or 48.6 million, in 2011, which was the biggest percentage drop since 1999.

But the uninsured rate in Kansas increased from 12.8 percent, or 350,000 people, to 13.1 percent, or 365,000.

Weisgrau said he is encouraged that Brownback is taking his time to study the Medicaid expansion issue, but he doesn’t believe the governor will opt in, given his other decisions related to the ACA.

In November, Brownback refused to partner with the federal government in setting up a health insurance exchange, touted as a one-stop place for people to compare and purchase health insurance.

“Kansans feel Obamacare is an overreach by Washington and have rejected the state’s participation in the federal program,” Brownback said.

Critics said Brownback’s decision cost the state an opportunity to set up the exchange in a way tailored to the needs of Kansans.

Brownback’s decision was no surprise. A year earlier, he rejected a $31.5 million federal grant to develop the exchange.

Supporters applauded the federal rebuff, but critics said Brownback was placating tea party Republicans.

Just weeks after bowing out of participating in the exchange, the Brownback administration received the go-ahead from federal officials to implement the state’s new Medicaid system, known as KanCare, on Jan. 1.

Under KanCare, nearly 400,000 Kansans will have their health care administered by for-profit managed care companies.

Brownback vowed that the new system will provide better health care more efficiently — ironically the same goals of the ACA. But the proposal has its detractors, such as the AARP and several other organizations that had asked for delays in implementation, saying that Brownback’s timeline was too aggressive.

In recent days, legislators who backed KanCare said they would file legislation aimed at allowing more legislative oversight over the Medicaid overhaul. That proposal will be debated next month as the 2013 session gets under way on Jan. 14.

Comments

Mike1949 1 year, 12 months ago

Brownback is full of crap! Kansans in the lower middle, and the poor do NOT think Obama health care isn't wanted. I don't know what percentage of Kansans are at or below poverty level (politicians lie about the figures constantly), but I know that every year that goes by, it is getting harder and harder to keep our house. Everything, and I mean everything keeps going up!

question4u 1 year, 12 months ago

Yeah, anonymous signs rule! They're always so full of wisdom, and they never exaggerate. There were some down by Westboro Church yesterday. They were hard to believe, but they must be true. After all, somebody made the signs.

Katara 1 year, 12 months ago

"Medicaid in Kansas doesn’t cover low-income adults who don’t have children. And a nondisabled adult with children is eligible only if his or her income is below 32 percent of the poverty level, which is approximately $5,000 per year. That is about the most difficult eligibility level in the country."

question4u 1 year, 12 months ago

Whether Medicaid is expanded “will directly impact a number of people, how they access services, how many people will get sick and die in the state,” Weisgrau said.

Why is there anything to "think over"?

just_another_bozo_on_this_bus 1 year, 12 months ago

For Brownback, et al, it's an ideological imperative that poor people must live miserably and/or die for lack of access to healthcare in order to give tax breaks to the Koch Bros.

Orwell 1 year, 12 months ago

Or you can pay federal taxes in Kansas so people in other states get the benefit and Kansans won't. Brilliant.

To quote Samuel L. Jackson. "Wake the _ up!"

Bob_Keeshan 1 year, 12 months ago

So if you haven't earned health insurance, then you've earned the right to die.

Republicans are awesome.

just_another_bozo_on_this_bus 1 year, 12 months ago

The plutocrats demanding to own everything (including access to medical care) in no way earned that right.

akt2 1 year, 12 months ago

Even if you have health insurance you still can't afford to get sick and use it. There are still co-pays, deductibles and co-insurance that you must pay. In case of acute illness you will still go bankrupt.

voevoda 1 year, 12 months ago

Are you your brother's keeper, disappointed_regressive? If so, why are you so determined that your brothers and sisters, fellow Kansans, should live in poverty and die of treatable illnesses?

akt2 1 year, 12 months ago

Try working around doctors right now. They are so pissed off they can't see straight. They know what's about to happen. Their reimbursements are going to be cut, the back log of patients is going to be great. Good time to get into healthcare if you want some job security. Or a good time to get out, depending on how you look at it.

appleaday 1 year, 12 months ago

Actually, most of the physicians and nurse practitioners I work around want health care reform. We're all tired of the insurance companies withholding payment for things we know our patients need, dictating what they will and and will not cover, and refusing to cover people with pre-existing conditions.

Katara 1 year, 12 months ago

Most of those in the medical field that I know are also pleased by the changes. Doctors and patients will have much more freedom to select the treatment that is best for them.

Kat Christian 1 year, 12 months ago

and this is only going to get worse. I am not eligible for Medicaid, yet I am raising my grandson and bring in under $15.000 from retirement. I have looked for work - even p/t (3 yrs now) to no avail, interviews a waste of time and now am so frustrated that I've given up and will have to wait 4 years for Medicare to kick in for me. I've resigned myself to the fact that if I become seriously ill I will most likely die, for lack of healthcare, unskilled doctors in this town and that I am just an expendable crew member on this earth as it would mean nothing to health officials if I die. This is sad, but I've lost my faith in the system, working community and social services assistance. I am hoping Obamacare kicks in and hope Brownback does not block it for us Kansans to gain access to it. At least its something.

akt2 1 year, 12 months ago

Certain types of physicians that are specialists still have private practices. They are not owned by hospitals, therefore they are able to set policy for their own practice. For example what hours they work, what insurance they take, will they or won't they write off the 20% that Medicare doesn't cover, will they accept Medicaid, will they accept new patients. When a patient's primary physician doesn't know what else to do, they are pretty quick to refer the patient to a specialist. Many of these doctors are in high demand. It is already a couple of months to get in to many of these doctors. It is great to think of the possibilites and changes that may come from healthcare reform. But some of the realities are going to be harsh.

just_another_bozo_on_this_bus 1 year, 12 months ago

"But some of the realities are going to be harsh. "

Not any harsher than the previous realities.

Bob Harvey 1 year, 11 months ago

You do know that it is against Medicare regulations for providers to write off the 20% patient portion of allowable charges. Physicians will be significantly more aware of insurance coverage, that is for sure. Personally I would be more concerned at the huge growth in advanced practice providers. If a physician needs four years of continued education and then three to four years of hands on training in residency why would I put the same faith in an advanced practice provider who has perhaps gone for two years in a Masters program?

riverdrifter 1 year, 12 months ago

Alas, yet another image of Sam with a grandiose Jesus-esque gesticulation. It makes me want to projectile hurl. So help me, the guy thinks he's Jesus. On the otherhand, I can tell ya what you can do with that pencil, Sammy.

KS 1 year, 12 months ago

Did not your Mother teach you that if you can't say something nice about someone, don't say anything at all? My guess is that she did not or you certainly were not paying attention.

just_another_bozo_on_this_bus 1 year, 12 months ago

"if you can't say something nice about someone, don't say anything at all?"

So, you're saying that no one can talk about Sam unless they're pathological liars, (and/or idiots?)

Linda and Bill Houghton 1 year, 12 months ago

There are some people that you can't say anything nice about. If you say nothing, you are aiding there cause.

riverdrifter 1 year, 12 months ago

KS, you wound me deeply (back of hand to forehead, sniffs).

1957 1 year, 12 months ago

Please,

Will all of you who think the direction of the current Kansas state government is so horrible and all of us who support it are so stupid and heartless move to the utopia known as California.

Write back and let us know how it works for you.

Bob_Keeshan, nobody is refused care if they don't have insurance. I know of two people personally who have ran up over a million dollars in bills with absouletly no way to pay.

just_another_bozo_on_this_bus 1 year, 12 months ago

"nobody is refused care if they don't have insurance."

This is not even remotely true. And if the two people you mention had had access to care well before they developed million-dollar illnesses, we'd all be better off.

Orwell 1 year, 12 months ago

Are you foolish enough to think you aren't paying for the health care provided to the uninsured?

1957 1 year, 12 months ago

Of course it is true, just because it does not fit your preconceptions does not make it false.

Kat Christian 1 year, 12 months ago

In the old days when someone was sick Doctors treated them instead of thinking how much money is involved in treating a patient first. Hypocratic oath is a thing of the PAST.

1957 1 year, 12 months ago

Not all doctors treat everyone so from that standpoint you are correct but there are doctors and hospitals that do. In fact if someone goes to an emergency room by law they must be treated, even if it is for something minor.

The argument is not that people do not get care, it is who pays for those that can't.

Katara 1 year, 12 months ago

There is not law that states if someone goes to an emergency room they must be treated. The law is the Emergency Medical Treatment and Active Labor Act (EMTALA) and just requires that the patient be stabilized if it is a life-threatening condition. It is only for emergency treatment.

http://www.emtala.com/faq.html

ThePilgrim 1 year, 11 months ago

As Weisgrau indicates above, Brownback is expected to follow Gov. Perry in Texas, as well as SC, in disallowing the expansion of Medicaid. Brownback is not "carefully considering". He is just waiting until after the first of the year to make the announcement so that he first can take credit for Kancare.

Larry Sturm 1 year, 11 months ago

The state should quit paying Brownback's insurance.

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