Editorial: Worst outcome

The governor’s decision takes away any role the state would have had in setting up health insurance exchanges that provide the best service for Kansans.

November 11, 2012


Kansas is primed to get the worst possible outcome of a federally run health insurance exchange, thanks to Gov. Sam Brownback’s decision not to support an application for a state-federal partnership.

Brownback previously rejected $31.5 million in federal funds that were allocated to enable the state to create the computer infrastructure for its own exchange. He said he expected the U.S. Supreme Court to overturn the federal law mandating creation of the exchanges. When that didn’t happen, he said he would await the outcome of the presidential election, assuming that Republican Mitt Romney would be elected and quickly have the law erased from the books. So much for that.

All along, the Kansas Insurance Department, guided by Lawrence’s Sandy Praeger, insurance commissioner, has been laying the groundwork for an exchange that could be operated by Kansans, for Kansans. Her staff had prepared an application that would have enabled Kansas to fill the roles of plan management and consumer assistance. Kansas would have received federal funds to spend on creating the partnership exchange, but only if Brownback supported the application for the funds and the 2013 Legislature authorized their expenditure.

Bye-bye. Kansas will have to live with the federal exchange. Apparently the governor is sticking us with the least palatable alternative, probably deliberately. His explanation rings hollow.

“My administration will not partner with the federal government to create a state-federal partnership insurance exchange because we will not benefit from it, and implementing it could cost Kansas taxpayers millions of dollars,” he said.

So Kansas will get the federal exchange. The expectation is that the default benchmark plan for Kansas now will be the largest health plan by enrollment in the state’s small group market. This is the Blue Cross Blue Shield of Kansas Comprehensive Major Medical – Blue Choice PPO product, amended to meet all the “essential health benefits” mandated by the federal plan. For plan years 2016 and beyond, the U.S. Department of Health and Human Services will revisit the “essential health benefits” benchmark approach to ensure that the EHB continues to reflect appropriate medical practices and insurance market protocol.

As William Allen White, the Emporia editor wrote in 1896 in his famous screed, “What’s the Matter with Kansas?”: “Go east and you hear them laugh at Kansas; go west and they sneer at her; go south and they cuss her; go north and they have forgotten her. Go into any crowd of intelligent people gathered anywhere on the globe, and you will find the Kansas man on the defensive. The newspaper columns and magazines once devoted to praise of her, to boastful facts and startling figures concerning her resources, are now filled with cartoons, jibes and Pefferian speeches. Kansas just naturally isn’t in it. She has traded places with Arkansas and Timbuctoo.”

If he came back today, White might conclude that little has changed.


Ken Lassman 5 years, 7 months ago

The Supreme Court has ruled that the ACA is indeed constitutional, so it would be a bit presumptuous for the good governor to claim otherwise. i would think at least the state courts would have to back him up, which they won't.

Alyosha 5 years, 7 months ago

Nullification may be a nice libertarian / Confederate fantasy, but it's not going to happen in reality. And all the while, back in reality, Kansas will indeed get the worst of all outcomes.

It's about time for voters and citizens to find and stay in reality and insist their elected representatives do so as well.

Kathy Theis-Getto 5 years, 7 months ago

Nullification was unsuccessful in this instance and many, many others. Nullification is unlawful and unconstitutional, but this does not mean that the states or the people have no recourse. The Constitution itself lays out the best path to change unconstitutional laws: object to the law and change opinions (and political leadership) in the political process, defund and slow its implementation, change or repeal the law, challenge it in the courts, and, if necessary, amend the Constitution. Obsurdities!

jhawkinsf 5 years, 7 months ago

What Jefferson or any other individual wrote about any particular subject is fine if used as a guide. However, ultimate authority is deferred to the Constitution. Then to the laws written by legislators and reviewed by our courts.

A letter by Jefferson indicated he opposed beating his adult slaves but was silent when he was asked about beatings of young slaves. The next time this issue comes up, I'll not refer to Jefferson but rather the Constitution.

jhawkinsf 5 years, 7 months ago

Sigh. Please do re-read my post. Jefferson's comments, or those of any person, may be used as a guide. A guide that has as it's ultimate purpose the interpretation of the Constitution. Your logic, my logic, is not the ultimate goal. The ultimate goal is to correctly interpret the Constitution. If, in the end, your logic is in conflict with said Constitution, then there are legitimate ways of changing that, just as there are illegitimate ways of changing it.

So basically, what I am saying is that if you choose an illegitimate way, you have closed your mind to legitimacy.

jhawkinsf 5 years, 7 months ago

Sigh, again. No, you did not comprehend my first post. I did indeed say that Jefferson's writing "may" be used as a guide. But then gave an example where it should not be. Both are true.

His writings may be a useful tool in reaching the ultimate goal of correctly interpreting the Constitution. Or they may not. But again, the ultimate goal is not to correctly interpret Jefferson's writings. It's not to find the logic in his writings. It's to correctly interpret the Constitution.

jhawkinsf 5 years, 7 months ago

"this issue" clearly, clearly, clearly was in the context of the paragraph it was in, dealing with whether or not it was appropriate to beat certain slaves. The next time THAT ISSUE comes up, I'll refer not to Jefferson's writings, but to the Constitution. If you want to argue Jefferson's point of view in regards to that issue, go ahead.

However, Jefferson may have had some other words of wisdom that we "may" find helpful as we interpret the Constitution.

I do believe, Liberty, you've lost this argument and are grasping at straws.

Jhawkinsf - 1, Liberty - 0.

mom_of_three 5 years, 7 months ago

nullification wasn't an immediate result of the Fugitive slave act. The first state didn't even pass anything until 1854.
fugitive slave act/enslaving human beings vs enacting healthcare legislation... yeah, slightly differently.

jafs 5 years, 7 months ago

It's just a bad idea.

Giving each state the ability to individually interpret the constitution for themselves kind of defeats the purpose of having a federal constitution that applies to the whole nation.

jafs 5 years, 7 months ago

The phrase "bad law" is subjective, and open to interpretation.

The whole point of a federal constitution is to ensure that certain rights apply across the whole nation - if states can decide for themselves how to interpret and apply the constitution, it defeats that purpose.

You do know, I imagine, that the remedy available in our system is to overturn a SC decision with a constitutional amendment?

jafs 5 years, 7 months ago

I don't like "bad laws", as I perceive them, to apply anywhere.

jhawkinsf 5 years, 7 months ago

Bad laws should be changed within the legitimate framework that exists for such change. Bad laws need not be broken just for the sake that they are bad. If however, one finds such laws so onerous that one feels compelled to break those laws, one must be willing to suffer the consequences. (Think Henry Thoreau).

jhawkinsf 5 years, 7 months ago

And that same framework provides a remedy. Geez.

Orwell 5 years, 7 months ago

The last time states tried to resort to "nullification" the cost included 600,000 Americans killed, and the federal law still prevailed. Everyone but the lunatic fringe learned this lesson.

Orwell 5 years, 7 months ago

You really don't get how this federal system works, do you?

If the DEA decides to bust potheads in Colorado or Washington there isn't a thing the state can do about it. The state may urge restraint, but the supremacy clause is still in full force and effect.

Of course if you feel raw about that you could always take up arms and march on Fort Riley. I'll hold your coat.

lama 5 years, 7 months ago

Pretty sure the South tried this and lost...

Orwell 5 years, 7 months ago

States can't "nullify" diddley. They may choose not to act in support of a federal law, in which case they abdicate local judgment in favor of federal control, but they can't act to inhibit its implementation or enforcement. "Nullification" is one of those wingnut buzzwords that are either meaningless or used inaccurately. If you hate the results of the elected representatives' actions so deeply you might want to consider relocation.

Kathy Theis-Getto 5 years, 7 months ago

See Abelman v Booth. You are incorrect Liberty. Perhaps you are confusing this with jury nullification.

just_another_bozo_on_this_bus 5 years, 7 months ago

I think we're better off with a federally run exchange than anything Brownback has a chance to get his grubby little fingers on.

Ken Lassman 5 years, 7 months ago

You know, that's what I thought, too, but from this article it sounds like Praeger has already done the hard work of putting together a state run program of identifying key players, received commitments, etc. Maybe all of that work won't be lost and the feds will just adopt what she's already put together.

chootspa 5 years, 7 months ago

I suspect half the reason he doesn't want it is to avoid giving Praeger another chance to show how competent she is.

Orwell 5 years, 7 months ago

Sadly, that's not how it works. If the state as a whole won't participate, the federal plan will be imposed. The Commissioner of Insurance can't take a role unilaterally. The governor has decided the state will forfeit its opportunity to have any control over the program that Kansans will pay for.

The simple reality is this: Sam Brownback would rather hold his breath, stamp his feet and let Kathleen Sebelius write the rules for Kansas. So much for conservative principles of local control.

Paul R Getto 5 years, 7 months ago

This will work out, with or without the Gov.

cowboy 5 years, 7 months ago

We will be better off with a fed exchange...

But all will remember the petulant Governor who refused to help his fellow Kansans who are sifted out of the pool by corporate for profit insurance companies. We know whose tune you dance to and it sure ain't Jesus.

skinny 5 years, 7 months ago

You guys crack me up. Someone always wanting something without working for it, in other words always wanting something for nothing. If you want health insurance go buy it like everyone else. Nothing is free!

"You cannot legislate the poor into freedom by legislating the wealthy out of freedom. What one person receives without working for, another person must work for without receiving. The government cannot give to anybody anything that the government does not first take from somebody else. When half of the people get the idea that they do not have to work because the other half is going to take care of them, and when the other half gets the idea that it does no good to work because somebody else is going to get what they work for, that my dear friend, is about the end of any nation. You cannot multiply wealth by dividing it."

cowboy 5 years, 7 months ago

You may want to actually read something about the AHCA. It does not give away insurance.

repaste 5 years, 7 months ago

The ACA agrees with people like you-it requires people to pay for their own health care. A little like car insurance their will always be people who say "they can't make me", so taxpayers take care of them when something happens. You know what percentage of Americans get Govt. healthcare today? 30-40%?

beatrice 5 years, 7 months ago

It is always funny to see people criticize something by describing it as the exact opposite of what it is. Before Democrats adopted the ACA, Republicans like Mitt Romney described it as the "free market solution" to healthcare needs in this country.

Alyosha 5 years, 7 months ago

This comment demonstrates a total lack of understanding of reality. No one is saying they want something for free; the ACA does not provide insurance for free. No one is saying they want something for nothing.

Your fantasy world complaints ring hollow in reality. And just as the Republicans wholly missed reality in the last election, being certain they would win and missing the reality-based projections they would not, certain citizens like this commenter continue to believe things which are not true (people just want something for free).

That's a terrible way to make public policy. Good thing the American voters rejected such thinking in the Presidential election, otherwise we'd have a President who is incapable of discerning reality and making decisions based upon the real state of affairs.

chootspa 5 years, 7 months ago

Which is why we should also have included a public option. Glad to see you coming around to the socialist point of view.

MyName 5 years, 7 months ago

Ummm so that whole thing about no longer being able to turn away people with preexisting conditions was them getting "something for nothing"?

Maybe that doesn't mean what you think it means...

voevoda 5 years, 7 months ago

"There is no question of relieving others at the cost of hardship to yourselves; it is a question of equality. At the moment, your surplus meets their need, but one day your need may be met from their surplus. The aim is equality."

voevoda 5 years, 7 months ago

Sure, in an anarcho-capitalist dream world: Everyone would start out life producing a surplus that they can put away. They never experience such a protracted downturn that their stored surplus runs out. No natural disaster ever wipes out everything they own. The companies they invest in never go under. They never get too sick to work, or have family members with life-threatening illnesses.

Prudence and thrift are fine qualities, Liberty_One, and I advocate them. But I'm not so unrealistic as to presume that prudence and thrift will obviate all need for external assistance. Helping each other is a great virtue, Liberty_One. It is blessed to give and to receive.

voevoda 5 years, 7 months ago

Here's what it has to do with government: Our government acts according to our values, aiding us in providing for the needy who otherwise would go without, because private charity is insufficient. I like this aspect of government. You don't. People like me are in the majority in this country, and consequently we have a government that reflects our will and not yours.

MyName 5 years, 7 months ago

Because clearly the best way to plan is to assume that you'll get cancer or some other disease and sock away a cool $100k. Or maybe you could pool up with other people and share that risk. Naw that scheme would never work IRL...

ruraljayhawk 5 years, 7 months ago

Ks will continue to deal with their PIPs, Punks In Power, as long as they continue to elect them. Brownback and Kobach have their own egos to feed and could give a crap less about anything else. Be thankful that they are no longer in a position to teach it.

Orwell 5 years, 7 months ago

A curious argument from NoSanity Sam : The federal government can run the exchanges at lower cost. Kinda argues against the RW mantra of transferring everything back to the states, doesn't it?

Cait McKnelly 5 years, 7 months ago

Kansas has elected a one party system of government. Deal with it.

Liberty275 5 years, 7 months ago

Quit whining and go to the federal exchange.

Alyosha 5 years, 7 months ago

It wouldn't have taken a rocket scientist to project that this would be Brownback's position, so one wonders why the same organization now writing this editorial supported and endorsed Brownback in the first place.

tomatogrower 5 years, 7 months ago

A Kansas exchange would probably only include the insurance companies who have donate money to his campaign. At least with the national exchange we would get more competition. A bad word for big business.

williamrock 5 years, 7 months ago

So many questions but not a lot of answers for those in need of health insurance that cannot get it for such reasons of pre existing conditions.. I have worked for some great companies in my career as an Internet Marketing Specialist and recently become more or less doing contract work and not collecting a paycheck nor company based health care so even if I wanted to pay a higher rate so far no insurance company so far has approved me… THIS SUCKS

I had been diagnosed many years ago for CRPS also known as RSD, this is a very painful nerve injury without a cure at this point. More information can be found about this at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004456/

I have no problem paying for insurance, however I cannot get insurance unless I work for an employer that has insurance, and that just SUCKS.

So my question is how is this going to effect people like me?

I make to much money to get state insurance, Nor do I want to have to rely on the government for my health care anyways.. Again I am willing to pay but can't.


Carol Bowen 5 years, 7 months ago

An insurance Exchange allows the consumer to compare plans with common criteria. If we have to use the federal insurance exchange, Blue Cross will be the only option in Kansas, because Blue Cross already meets the federal criteria for comparison.

I wonder if one could still purchase insurance not on the exchange. It is just an advantage for the consumer. I have read that you can continue whatever plan you already have.

The insurance exchange allows us to compare health care plans and costs before we choose. Many large employers already have uniform insurance comparisons for their employees. The exchange is free enterprise for providers and consumers. Isn't free enterprise one of the principles supported by the GOP?

See http://www.healthcare.gov/law/features/choices/exchanges/index.html for more information.

Fred Whitehead Jr. 5 years, 7 months ago

Wow!! Put up a "blue" mark with a "red" piece of chalk!! The management and owners of this news rag are jumping on their wunderkind in Topeka, ole Sammy Brownbackwards!!

The managers and editors of the JW have run editorials lauding the advanttages of having the republican terrorist party in command of our destiny. And now they suddenly notice that this knucklehead governer they all supported is really a terrible leader for the state.

But in all honesty, I think I might agree with some of you that letting the federal government handle this fask may be the lesser of two evils, as opposed to any scheme that Brownbackwards and his thugs may concoct for the people of Kansas.

Scott Tichenor 5 years, 7 months ago

Correct me if I'm wrong but LJW endorsed Brownback for Governor.

Time to eat your own dog food.

Jean Robart 5 years, 7 months ago

c'mon---everybody makes mistakes. Not everybody who makes mistakes admits them...

Cait McKnelly 5 years, 7 months ago

This is from the Wichita Eagle. I just couldn't pass it up.

Cait McKnelly 5 years, 7 months ago

By the way, to you people that think the Journal World endorsed Brownback, get something straight. DOLPH SIMONS (the owner of the paper) endorsed Brownback. I seriously doubt the editorial board had much to do with it, so cut them slack, please.

In_God_we_trust 5 years, 7 months ago

Actually the answer to high insurance prices is to allow market forces to act. Drop your insurance like a "union" of people and force them to price health insurance where you want it to be. Then buy back your insurance once the price has come down. Supply and demand. It is better than Obamacare and probably cheaper and faster without socialism being involved.

The reason people haven't done this is because they are afraid to do without insurance for any length of time and they are afraid of any temporary sacrifice or risk.

just_another_bozo_on_this_bus 5 years, 7 months ago

That might work fine-- for about 1/4 of the population.

voevoda 5 years, 7 months ago

We have the "supply and demand" system you advocate now, and insurance prices just keep going up. That's because it's irresponsible to do without insurance until the price drops. The price wouldn't drop fast, and the people who get seriously ill while they didn't have insurance would have no recourse. That's a whole lot worse than a "temporary sacrifice;" it's potentially catastrophic. And it's not only catastrophic for the individuals; it's expensive for the taxpayers, who end up picking up the costs of the health care uninsured patients end up needing.
The ACA doesn't involve "socialism." People buy their insurance from private companies and use it to seek care from private providers.

Carol Bowen 5 years, 7 months ago

That would be the exchange program. All insurance programs would be front and center for our comparison. This is part of the ACA.

In_God_we_trust 5 years, 7 months ago

@voevoda, the only way any supply vs. demand system is going to work to bring down prices is for people to refuse to pay them, and take action on the demand side where supply goes up. Your example is an excellent example of what is wrong with the people. You state that the prices just keep going up. Yes they will until you do something on the demand side to control prices. Basically what you are saying is it is because of fear that you refuse to stand up and do something and organize with others to help bring down prices. So that is why the government needs to do it for you. That is socialistic. What did people used to do before health insurance?

lucky_guy 5 years, 7 months ago

"What did people used to do before health insurance?"

They died alot.......Did any of you guys go to college? Health care costs are "inelastic" remember that? You might stay home with a heart attack to protest the high cost of health insurance but you are not going to risk the health of your children to prove a point that is at best ineffective and otherwise stupid. Get this "In_God" the government is the only entity that can stand up to insurance companies and make them act like good citizens. That is because the insurance industry crosses state and even national borders so no group of subsribers can really effect them in any large way like making them drop their prices. Corporations are people according to the SCOTUS and they are acting like spoiled children, especially insurance companies.

Trumbull 5 years, 7 months ago

In_God, Obamacare is not Socialism. In some ways, it aids the free market system (on the consumer side), by increasing options and the availability of more insurance plans to choose from. Even a single payor system or a public option does not come close to Socialism. Most hospitals, doctors, and health care workers operate independently of the governemnt. Just because they are subject to regulations does not make it Socialism.

Richard Heckler 5 years, 7 months ago

There is one way to eliminate this Brownback fiasco.

Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private.

Currently, the U.S. health care system is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($8,160 per capita), the United States performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates. Moreover, the other advanced nations provide comprehensive coverage to their entire populations, while the U.S. leaves 51 million completely uninsured and millions more inadequately covered.

The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.

Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork, more than $400 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do.

Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.

Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO / group practice. Hospitals would receive a global budget for operating expenses. Health facilities and expensive equipment purchases would be managed by regional health planning boards.

A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled through negotiated fees, global budgeting and bulk purchasing.


George Lippencott 5 years, 7 months ago

If only all of that were real. I can not think of a single thing that our federal government has done or attempted to do that did not cost more and provide less than advertised

George Lippencott 5 years, 7 months ago

There is a point in the affairs of men where you cut your losses. With the ACA, we are there. Further rearguard resistance will not only be futile but Pyrrhic! We need to participate in the planning for the implementation of the insurance exchanges because they are going to happen – period. We also need to accept the changes in Medicaid and expand coverage for those citizens of low income not currently covered (mostly single people and those without children). Kansas has never been generous with Medicaid coverage and we can continue that tradition but with some compassion for those with no insurance and no significant ability to buy it.

bevy 5 years, 7 months ago

Because if we don't, we will end up paying for those people's healthcare anyway - just as we do now - through higher prices. Insuring them is cheaper, and the more compassionate solution. I know, my husband and I went bankrupt from major medical expenses for our daughter. We were both working full-time, but neither had insurance available and we made too much money for any Medicaid help, but not enough to buy our own insurance.

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