Lt. Gov. Jeff Colyer

Topeka ? Kansas Lt. Gov. Jeff Colyer raised eyebrows on Dec. 15 when he took to Twitter and predicted the imminent demise of the Affordable Care Act, the federal health care law also known as Obamacare.

“Obamacare/Expansion will soon be dead. Time will bring clarity from D.C.,” Colyer said in part of the tweet.

Colyer, a plastic surgeon by profession who has been Gov. Sam Brownback’s point person on state health care policy, drew jeers for that tweet, mostly from people and groups who commonly criticize the administration on Twitter.

But in an interview with the Journal-World this past week, Colyer stood by the statement.

“It’s pretty obvious that the House and the Senate and the President(-elect Donald Trump) have all said that they were elected to repeal Obamacare, and I take them at their word,” Colyer said.

His tweet also appeared to some as a pointed message to many of the newly elected legislators who had campaigned saying they would support expanding the state’s Medicaid program, as allowed under the federal law.

Colyer said he doesn’t see that as a realistic possibility.

“I think it is unlikely that the Trump administration will expand Obamacare,” he said. “And even if he did, it would take a long time to get there. It doesn’t just happen overnight. That’s a couple-year process.”

Repealing Obamacare

During the 2016 campaign, Trump and many Republicans running for Congress vowed that they would vote to repeal the Affordable Care Act in its entirety.

Since the election, however, Trump has softened some of his campaign rhetoric about repealing Obamacare, suggesting there may be elements of it he would keep, like allowing children to stay on their parents’ policies until age 26 or the ban on denying coverage due to pre-existing conditions.

But it remains unclear what his intentions are, or those of the Republican-controlled Congress, about other key elements: requiring virtually all adults to carry health insurance or pay a tax penalty; allowing states to expand Medicaid to cover individuals with incomes up to 130 percent of the federal poverty level; and, for people with incomes above that, offering subsidized private insurance through government-run marketplaces called exchanges.

Tom Bell, president and CEO of the Kansas Hospital Associaiton, said he thinks it’s still too early to write the Affordable Care Act’s obituary.

“We don’t know for sure they’re going to repeal the ACA,” he said. “It’s probably going to happen, but don’t know. And what its replacement looks like is anybody’s guess.”

The hospital association and other health care groups in Kansas have supported expanding Medicaid, arguing that by not taking advantage of the law, Kansas hospitals and health care providers are losing out on potentially hundreds of millions of dollars a year in federal reimbursements. They also argue that rural hospitals that are already under financial strain are hurt the most.

Nationwide, an estimated 20 million people who didn’t have health coverage before have gained coverage under the Affordable Care Act, according to the U.S. Department of Health and Human Services.

Future of KanCare

The purpose of Colyer’s tweet was to announce that the administration had extended its contracts with the three private health insurance companies that currently manage the Kansas Medicaid program, known as KanCare. Those contracts were scheduled to be re-bid this year.

“We have extended the contracts so that as things unfold, Kansas can be first in line to take advantage of whatever changes are coming down from the administration,” he said. “Otherwise, the contracts would have been rebid under Obama but implemented under Trump, and that didn’t make a whole lot of sense.”

If the new Trump administration and its Republican allies in Congress succeed in repealing Obamacare, Colyer said he expects to see big changes in Medicaid, possibly by converting it into a block grant program. And he said Kansas would be in a good position to change to that kind of funding system.

“That’s what the (incoming) administration has said,” he said. “Now, what that block grant looks like is unclear. And we need the time to see how that turns out.”

Currently, most states operate their Medicaid programs on a fee-for-service basis. Like other insurance programs, they pay health care providers a set fee for each office visit, procedure, surgery or prescription medication. The cost is split between the state and federal governments, using a formula that’s tied to the poverty rate in each state.

But some states, including Kansas, have switched to a “managed care” model for Medicaid. In Kansas, the state hires private companies, known as managed care organizations or MCOs, and pays them a flat annual fee for each patient to manage that patient’s medical needs.

Kansas had a similar system in place for children and families in Medicaid long before Brownback and Colyer were elected. Under KanCare, though, that model was extended to the two categories of patients that have the costliest and most unpredictable health care needs: the elderly and disabled.

Colyer was the chief architect of that plan.

“Everybody said, what we really need to do is have people see their doctor more, visit the ER less and spend less time in the hospital,” he said. “KanCare is the first integrated Medicaid program to actually accomplish that for the 24 percent who are elderly and disabled, but also for the general population. The number of doctor visits are up, the number of ER visits are down, but our hospital days are down 24 percent.”

Because of that, Colyer said, Kansas would be in a good position to make the transition to a block grant funding system for Medicaid, whatever that may look like.

“I think the bottom line is, there are going to be a lot of changes that are happening in Washington, and Kansas can be well placed to take advantage of them,” he said. “How those details will work out is unclear right now. There are going to be dramatic changes in D.C., and we want to be well placed to do that. We want to work with the Legislature to take advantage of them. We’ll be working that pretty hard as they come down.”

Bell, however, said he believes Kansas would be in a better position for a block grant program if Kansas expanded its Medicaid program while there is still a chance.

“That block grant will be based on a certain amount of money, and it’s probably going to be based on what states are getting now,” he said. “Michigan, which has expanded, would get a huge block grant, but Kansas, which hasn’t expanded, would get a very small grant. Kansas should be putting itself in a position to get the biggest possible block grant that it can.”

Other health care initiatives this year

Besides waiting to see what happens in Washington with the Affordable Care Act, Colyer said the administration hopes to move ahead on other health care initiatives this year.

“One of the things the governor asked for (in his 2016 State of the State address) was to have a rural health care task force,” he said. “That task force met and they’ve made a lot of recommendations. We’ve just seen a lot of ideas that are out there.”

The first priority, he said, will be to restore the 4 percent cut in reimbursement rates paid to Medicaid providers. That cut, estimated to save $38.2 million, was part of the $97 million in allotment cuts Brownback ordered in May to balance the state budget.

Another, he said, will be to address the shortage of health care providers in many rural parts of Kansas, possibly by expanding residency programs or opening new ones in rural communities.

“People are more likely to stay and serve in Kansas if they do their residency training here,” Colyer said.