Topeka Concern about the future of St. Francis hospital in Topeka, as well as at least two other hospitals in the state, is prompting some lawmakers to say they'll try again to pass a Medicaid expansion bill when the Kansas Legislature comes back into session May 1.
"We are working hard to make sure there will be a continued or renewed debate about Medicaid expansion when we return for the veto session," said David Jordan, who heads the Alliance for a Healthy Kansas, a group that has been pushing for Medicaid expansion.
"I do think that legislators should be looking at the impact that the failure to expand Medicaid has on hospitals," Jordan said. "They see that this is partially responsible for the potential closure of St. Francis as well as a few other hospitals."
St. Francis is a 378-bed nonprofit hospital that was established in 1909 by the Sisters of Charity of Leavenworth, an organization now known as SCL Health, based in Denver.
In May 2016, St. Francis and SCL announced they were putting the hospital up for sale. Since then, however, no sale has been announced, and on Friday Gov. Sam Brownback and Kansas Attorney General Derek Schmidt issued statements suggesting that closure of the hospital may be imminent.
The Topeka Capital-Journal has reported that an announcement is expected Tuesday. SCL Health did not confirm or deny that report on Monday.
"We have no announcement at this time, but will keep our dedicated associates and physicians, and the community they serve informed when we have definitive news to share," SCL Health spokesman Brian Newsome said in an email message Monday. "In the meantime, we remain resolutely focused on providing the quality, compassionate care for which St. Francis has become recognized."
If St. Francis closes, it would be the second major hospital closure in Kansas in the last two years, following in the footsteps of Mercy Hospital in Independence, which closed in October 2015.
At that time, many people cited the state's refusal to expand Medicaid as one of the factors that led to the Independence hospital's closure. And officials at St. Francis cited it as well when they announced that the hospital was being put up for sale.
In addition, Mercy Hospital Fort Scott announced in March that it would begin to pare down its operations in reaction to what it called a changing health care environment. Although the hospital did not warn of an impending closure, officials said the reductions could include eliminating some services and reducing its staff.
Hospital president Reta Baker also cited the lack of Medicaid expansion as one of many factors affecting that hospital.
"In addition to the lack of Medicaid expansion, just a few of the other issues causing changes at Mercy Fort Scott include low volumes, outmigration, rising costs from outside sources to provide health care such as increased drug costs, and decreased reimbursement from all payer sources," Baker said.
"I don't see how you can divorce the two," said Sen. Laura Kelly, a Topeka Democrat whose district includes St. Francis. "By not expanding Medicaid, we devalue every hospital in the state."
Expanding Medicaid was one of the key elements of the Affordable Care Act, also known as Obamacare, that were intended to provide health coverage to virtually all Americans. The law also mandated that large employers offer health plans to their full-time employees. And for people who could not access coverage through work, the law offered subsidized individual policies that are sold through online "exchange" markets.
In order to pay for those programs, however, the law also reduced payments to hospitals through Medicare, the federal health insurance program for the elderly. Hospital lobby groups agreed to accept those reduced payments under the theory that they would no longer have to provide charity care to the uninsured because virtually every patient would have coverage.
In 2012, however, the U.S. Supreme Court struck down a provision of the law that said states were required to expand their Medicaid programs, which are jointly funded by states and the federal government. Instead, the court said, Congress could only make Medicaid expansion an option.
As a result, hospitals in states like Kansas that have not expanded Medicaid are seeing the reduced payments from Medicare. But hospital officials say they are still providing large amounts of uncompensated "charity" care to the uninsured.
In Kansas, expanding Medicaid would extend coverage to an estimated 150,000 to 180,000 individuals who live in households with incomes up to 138 percent of the federal poverty level, or about $27,180 a year for a family of three.
Republican Gov. Sam Brownback, however, has been a harsh critic of the Affordable Care Act. And while he has not flatly refused to consider expansion, he has laid out conditions that some lawmakers consider unacceptable, such as including a work requirement for adults and eliminating the current waiting lists for nonmedical services for people who receive Medicaid-funded home- and community-based services.
In March, Kansas lawmakers passed a Medicaid expansion bill without those provisions and Brownback vetoed it the next day. An attempt to override the veto failed by three votes in the Kansas House on April 3.