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Archive for Monday, June 10, 2013

Medicaid expansion would cover thousands in Douglas County

June 10, 2013

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Thousands of Douglas County residents will continue to go without health insurance once the Affordable Care Act goes into effect next year unless Kansas decides to expand Medicaid as called for in the law.

One of the ways "Obamacare" hoped to get America closer to a goal of universal health coverage was by easing the eligibility requirements for Medicaid. But after the U.S. Supreme Court ruled that the federal government couldn't force states to do so, 20 of them — all of but two of which, including Kansas, have Republican governors — have so far opted not to loosen the requirements; another eight are still weighing their options.

Opponents in Kansas, including Gov. Sam Brownback, say they don't trust the federal government to follow through on its commitments and that the costs of the program would take away from spending on core services like education.

In Douglas County alone, it's estimated that the measure could increase coverage to as many as 11,400 of the 16,000 residents who currently don't have insurance.

"Without the ability to expand Medicaid, that's going to continue the plight of the uninsured in Douglas County and around the state," said Lawrence Memorial Hospital CEO Gene Meyer, who estimated that without the expansion as many as 8,000 people in the county will continue to go without coverage.

The broadening of Medicaid would cover practically the entire patient population at Lawrence's Heartland Community Health Center, enabling the clinic to handle significantly more than the 12,000 to 14,000 visits a year it has the capacity for now. Until then, the practice will, through measures like cost-shifting, continue to pick up the tab for about half of its patients.

Medicaid expansion also would extend coverage to many of the clients at Health Care Access, which treats uninsured Douglas County residents making up to 158 percent of the federal poverty level.

Hospitals in trouble

To help pay for the expanded coverage, the Affordable Care Act reduces Medicare reimbursement to hospitals, on the theory that they would make up the difference from the additional Medicaid patients. But in states that have opted not to expand eligibility, hospitals are going to have to endure significant cuts.

Lawrence Memorial Hospital expects to lose between $2.2 and $4 million in Medicare reimbursements in 2014 without getting any extra Medicaid patients. That's on top of a $750,000 reduction in federal funding this year due to sequestration cuts. Meyer said the hospital has yet to begin its budgeting process for next year but is confident it can sustain the reductions without resorting to drastic measures such as layoffs.

About 40 percent of the budget at Bert Nash Community Mental Health Center in Lawrence comes from Medicaid. But in the past five-plus years the state has cut the facility's funding significantly, causing it to reduce staff and programs.

"I believe that expanding Medicaid would mean more for Douglas County than virtually any other county in the state," CEO David Johnson said, pointing to its higher-than-average poverty rate coupled with the small number of residents who are eligible for Medicaid. "For us, it would be a big deal — we provide services to people regardless of their ability to pay."

Strict eligibility

As it stands, Kansas has some of the strictest eligibility Medicaid requirements in the nation. To qualify, you can't earn more than 32 percent of the federal poverty level ($3,677) or have assets worth more than $2,000. Nondisabled childless adults aren't eligible for the program under any circumstances.

The Affordable Care Act opens up eligibility to all people within 138 percent of the federal poverty level, or $18,154. The law's online health care exchanges, meanwhile, provide subsidized premiums to Americans who make between 100 and 400 percent of the federal poverty level ($11,490 to $45,960).

But If Kansas doesn't expand Medicaid, residents whose incomes fall within that 32-to-100-percent range would get nothing. That means a Kansan who earns $45,000 a year would receive government assistance to purchase health insurance while a childless adult making $4,000 would not. On top of that, the law mandates that all Americans have some type of coverage or they will face a tax penalty.

The opposition to the expansion isn't strictly along party lines. State Rep. Tom Sloan, R-Lawrence, believes Kansas should accept the federal money on the table, estimated at roughly $400 million a year, with Washington covering 100 percent of the costs from 2014 through 2016 before winding down to a 90/10 split by 2020.

Michael Fox, a professor of health policy and management at Kansas University, believes it's only a matter of time before the holdout states decide to participate, as many are feeling pressured to by their hospital industries and business communities.

"If they follow their fiscal conservatism rather than their strict political ideology I think what they will see will be an enormous financial advantage to Medicaid expansion," he said. "Medicaid has shown to be a very cost-effective and efficient program."

Comments

jonstewart 10 months, 1 week ago

HCHC recorded just over 5,000 patient visits in 2012.

What I mean about "capacity" is this: When HCHC was designated a Community Health Center about a year ago, it came with a large annual grant to be used to help hire the staff (admin, front office, clinical support) that would be required to support 3 primary care providers and 1 mental health clinician. We currently have the resources to recruit and retain the team that would provide 12-14,000 visits annually. These are projected numbers we will meet when fully staffed

As already mentioned we are not yet fully staffed. We are still in the process of recruiting the providers and have been relying on an array of temporary physicians until we find the right fit. There is a serious shortage of primary care providers so recruiting is challenging.

Finally, if access to Medicaid coverage were to expand in Kansas, it would increase the numbers of people we serve well beyond the projections above. About 70% of the patients we see are without insurance. Because the revenue generated from patients with insurance is greater than for those without insurance, we would be in position to hire more staff to see even more patients.

I hope this clarifies it.

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redpurse 10 months, 2 weeks ago

Good Questions Mamiesmission! I would love to see the answers to those questions as well.

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Mamiesmission 10 months, 2 weeks ago

How can HChC document so many visits as reported without Providers? The statistics don't add up. They are supposedly seeing a large amount of patients but have no clinical providers. Why are the providers they do hire leaving so quickly? Mr. Stewart claims to be "staffing up" yet still cannot provide any full time clinician care for patients. Is it true that HCHC are no longer accepting patients because they cannot care for them? Is our tax money providing salaries for the top heavy mismanagement of HCHC?

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toe 10 months, 2 weeks ago

National health care will never work unless is is rationed. When that finally dawns on everyone, then there is a possibility that national healthcare will be viable. The private solution involves some rationing with a hospital component that requires care regardless for severe problems. But, all healthcare must be rationed. Some will deserve more expenditures than others. Health care may be a human right, but humans do not have unlimited resources for anything and everyone. A basic plan that takes into account age, ability, and return to society, then we will be on our way to a decent health system. If you want more coverage, pay up.

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redpurse 10 months, 2 weeks ago

Sorry Heartland but just because you receive grant money it doesn't make your "capacity immediately increase"! You actually have to have staff (clinicians) to do the work. This just doesn't make sense to me still. Also what do you mean by your last paragraph Jon? IF more of your patients had coverage you could double your capacity? That's why you received the grant money! So you could see more patients!

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jonstewart 10 months, 2 weeks ago

Sorry for the confusion. HCHC has the CAPACITY to see the patient volume mentioned. When funded last year, HCHC's capacity immediately increased to more than 12,000-14,000 because of a substantial annual grant.

As planned, HCHC has been gradually staffing up over the year to meet this capacity...adminstrative staff, clinical support personnel and clinical providers. The most challenging to recruit and hire has been clinical providers. It hasn't been a linear process and until these providers are hired, temporary providers with erratic schedules have been filling in. This has been unfortunately disruptive to our patients. They are asked to see a different provider each visit or are having trouble arranging an available appointment. But help is on the way.

The good news is that by early fall HCHC should be fully staffed with not just 1 but 2.5 full time primary care providers alongside our full time mental/behavioral health provider.

The point in the article about HCHC is that IF medicaid had expanded, IF 70% of our paitents had coverage (instead of 30% currently), our capacity would double the volume mentioned.

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redpurse 10 months, 2 weeks ago

Regardless of the Affordable Care Act everytime I read an article about Heartland Health Clinic their numbers never seem to add up to me. Perhaps this is a misquote that they saw 12,000 to 14,000 people last year? They haven't even had a full time provider since August of last year! And IF they had a full time provider that person would have seen on average of 6.7 patients an hour. Sorry but since they DIDN'T have a full time provider, I find this an impossibility. It seems everytime something is wrote in the paper there are many different quotes of what they are doing. Has anyone ever really checked? This is something that continues to make me go.....hummmm....and scratch my head. I'm not saying they don't do meaningful work I just think its about time someone gets the story straight........either LJworld or Heartland needs to be consistent with what they are reporting. I know someone may suggest this post for removal, I just hope someone who can really do an accurate story and get good hard data for an accurate story sees this first.

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Andy_LCS 10 months, 2 weeks ago

HHS has stated that individuals eligible for Medicaid under expansion will not be penalized if their State decides not to expand. Though I am not clear why anyone eligible would remain in a state that doesn't expand it when 30 other states are.

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Kate Rogge 10 months, 2 weeks ago

The economic argument that preventive care coverage reduces emergency and expensive end-of-life costs to the rest of us is less important, in my opinion, than the simple fact that thousands of Kansans have no health care coverage and live on the edge of disaster. Think how many families' lives are harmed by not having simple health care. Why would we choose to continue this harm just to make a political point?

Why not take the Federal money to help our fellow Kansans receive medical treatment before, not after, their illness becomes irrecoverable? Why must these people pay with their lives as a floor show for Brownback's ideology and political aspirations?

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Fred Whitehead Jr. 10 months, 2 weeks ago

And with the Koch brothers bought-and-psif for "governer", this will contine ue. And as long as the low-information voters (of Rush Limbaugh) keep electing these dolts, we will continue to be vidtims of the Republican Terroist Party of Kansas

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Richard Payton 10 months, 2 weeks ago

Wonder how many people will claim to be Anabaptist to avoid the penalty tax? Also, certain Indian tribes can be exempt from the Obamacare tax.

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reality_check79 10 months, 2 weeks ago

ACA has lost support across the country in the last few months. Labor unions (one of ACA's biggest supporters) have turned against it, the govt is months behind in setting up regional offices to handle issues that will arise, and still no clue of cost! When the majority of Americans don't want it and the feds are so far behind schedule they are already talking delays, and the odds of this not turning into One Big Asinine Mistake America are astronomical!

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friendlyjhawk 10 months, 2 weeks ago

"Opponents in Kansas, including Gov. Sam Brownback, say they don't trust the federal government to follow through on its commitments and that the costs of the program would take away from spending on core services like education."

Very interesting quote from the article. This fool of a governor makes it clear why most of us in the state don't trust him.

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appleaday 10 months, 2 weeks ago

Sandy Praeger, the state Insurance Commissioner, is pushing the state to expand Medicaid as well. Remember, the uninsured will continue to get the most expensive treatment in the form of emergency department care, if they don't have preventive care coverage. And those costs will be passed on to everyone else in the forms of higher insurance premiums and higher out of pocket expenses.

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