Archive for Thursday, March 30, 2017

Brownback vetoes Kansas Medicaid expansion bill; lawmakers postpone override vote

In this photo shared by the governor's office Thursday, March 30, 2017, Kansas Gov. Sam Brownback vetoes a bill that would extend Medicaid coverage to an estimated 150,000 people.

In this photo shared by the governor's office Thursday, March 30, 2017, Kansas Gov. Sam Brownback vetoes a bill that would extend Medicaid coverage to an estimated 150,000 people.

March 30, 2017, 9:48 a.m. Updated March 30, 2017, 3:16 p.m.

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Topeka — Kansas lawmakers will spend a three-day weekend getting an earful from constituents about whether they should or should not override Gov. Sam Brownback’s veto of a bill that would extend Medicaid coverage to an estimated 150,000 people, most of whom are currently uninsured.

Brownback issued his veto around 9:30 a.m. Thursday, barely half an hour before the House came into session, asserting among other things that the bill would have provided care to “able-bodied adults” while elderly and disabled Medicaid recipients are on waiting lists for home- and community-based services. He also cited an outside actuary’s estimate that it would cost the state $1.2 billion over 12 years.

“Furthermore, this legislation ensures a significant increase in state and federal Medicaid dollars funneled towards abortion providers like Planned Parenthood,” Brownback said in his veto message.

The House immediately took up a motion to override the veto.

“I have sat in this body for 15 years and never heard a more dishonest statement than we just heard,” said an emotional Rep. Jim Ward, the House Democratic Leader from Wichita. “The governor pits working poor against the disabled.”

“If we allow this veto to stand, people will die. Hospitals and clinics will close,” Ward said.

The cost estimate that Brownback cited was conducted by the firm Aon Hewitt in 2015 for the Kansas Department of Health and Environment, and its findings have been widely disputed by other groups.

The Legislature’s own nonpartisan Research Department estimated it would cost the state only $27.4 million for the last half of the upcoming fiscal year, because the bill would not take effect until Jan. 1, 2018, and $62.1 million in the first full year of operation.

The timing of Brownback’s veto was conspicuous because Thursday was the deadline for the House and Senate to consider bills from the other chamber, except those that are exempt from deadlines. Both chambers were scheduled to adjourn Thursday for a three-day weekend, then return Monday to work on budget and tax bills, as well as other bills in conference committees.

Democrats tried twice to adjourn the House for the weekend, which would have given them time to round up the votes supporters of the bill would need for an override, but both of those efforts failed.

The bill passed the House on Feb. 23 by a vote of 81-44, which is three votes shy of the two-thirds majority needed to override a veto. It passed the Senate on Tuesday by a vote of 25-14, which is two votes shy of the two-thirds majority needed in that chamber.

The House continued debate Thursday for more than an hour as emotions ran high in the chamber.

“When do we as a body run from our moral duty to our constituents?” asked Rep. John Eplee, R-Atchison. “Now our governor — and I was troubled over this also — presented this as an abortion bill, and I’m still having a hard time wrapping my head around that.”

In fact, federal law prohibits Medicaid programs from paying for abortion services. Planned Parenthood clinics, however, are eligible for reimbursement for other services it provides such as cancer screening, family planning and other services that the organization says make up about 97 percent of all the services it provides.

Rep. Chuck Weber, R-Wichita, however, repeated Brownback’s assertion that people coming into Medicaid under the expansion program would squeeze traditional Medicaid recipients out of the health care market.

“KanCare is a disaster, but we’re going to dump, what, 150,000 people onto the marketplace?” he said. “Who is going to take care of them, and who is going to get shoved to the back of the line? The disabled, the mentally ill, pregnant women, the elderly.”

Finally, Rep. Russ Jennings, R-Lakin, pointed out that one member of the House was absent. That was Rep. Linda Gallagher, R-Lenexa, who was reportedly out of town attending a funeral in western Kansas, roughly five hours away.

Gallagher voted in favor of the bill in February.

Jennings pointed out that if the override motion came to a vote, there would certainly be a “call of the House” — a procedure that compels all House members to return to the chamber — and the House would have to sit still for the rest of the afternoon waiting for her to return and unable to act on any other bills that were on Thursday’s calendar.

Jennings then offered a motion to “table” the override vote, which essentially put the issue aside for a later time. Under the Kansas Constitution, lawmakers have 30 calendar days after receiving a veto message to vote on an override.

The debate over Medicaid expansion in Kansas is taking place against the backdrop of deep national divisions over whether to continue the federal health care law that makes it possible, the Affordable Care Act, also known as Obamacare.

President Donald Trump campaigned in 2016 on the promise that he would repeal and replace Obamacare as soon as he was sworn into office. Last week, however, the Republican-controlled U.S. House called off a scheduled debate on their plan to overhaul the program amid a split in the GOP caucus between moderates who said it would take away coverage from millions of Americans, and conservatives who said it didn’t go far enough toward repealing Obamacare in its entirety.

Trump said afterward that he would shift his focus to other issues, but Republican leaders in Congress have said they will continue trying to overhaul the program.

Tweets from statehouse reporter Peter Hancock

Comments

Phillip Chappuie 4 months, 3 weeks ago

Our dear Governor's explanation is woefully inadequate in that it displays his complete ignorance of the issues at hand. A good many of the new eligible persons do work in low paying jobs and cannot afford insurance. It does not cut out any of the more vulnerable individuals that this Governor already underfunds for services. The bill contains caps for federal reimbursement, at which point we would withdraw from the program. And it is already against the law to use federal funds for abortion services. His comments are disingenuous at best. It again shows just how out of touch with Kansas reality Sam Brownback is. The real outcomes we will miss it the savings from cost shifting by not providing unpaid care in ER's and access to wellness to prevent conditions from becoming chronic or critical. Hey guys, pay for it in taxes coming back to Kansas from the federal government or pay for in your own premiums cost shifted to cover the unpaid care. The answer is simple. But then again so is our Governor. He probably doesn't understand the health care can be so complicated.

Bill McGovern 4 months, 3 weeks ago

Brownback: Pro birth, not pro life. He tries to make himself sound like a God, saving babies when in reality he is just hurting the rights of women. Keep your religion out of politics you whack job.

Clark Coan 4 months, 3 weeks ago

Not completely consistently evil. He ordered KDOT to find money to finish the 117-mile Flint Hills Nature Trail, the longest trail in Kansas (it's a rail-trail stretching between Osawatomie and Herington). So, KDOT is allocating federal Transportation Enhancement funds to the project and Kansas Dept. of Wildlife and Parks is paying contractors to build it. They have completed several sections.That said, Brownback does conveniently seem to forget Jesus' message to help the poor. I'm glad he is going to Rome, though he will try to mess up the UN Food Programme.

RJ Johnson 4 months, 3 weeks ago

The State of Kansas can't even fund our Public Employees Retirement system! Where do you guys think we were going to get the money to fund this???? We are already in the hole! You guys must think money grows on trees!

Andrea Zuercher 4 months, 3 weeks ago

The federal government has funded 100% of the Medicaid expansions in the 32 states that have expanded Medicaid. This means that we have been paying our federal taxes for other states' Medicaid programs to expand but not our own. In 2017 the federal match goes down to 95%, in 2018 to 94%, etc. So we've already missed out on federal funds to make sure our fellow Kansans don't die on waiting lists, or postpone preventive care or chronic disease care and develop expensive illnesses, or have to go to crummy nursing homes because they can't get help paying for their few hours a week of personal assistance at home. Or disabled kids can stay home with their families and out of institutions. I'd much rather pay for those things than pay for rich people not to pay taxes.

RJ Johnson 4 months, 3 weeks ago

See, that is your problem Andrea, you are not entitled to others money!!!

Alex Landazuri 4 months, 3 weeks ago

you missed the point entirely RJ. we are paying into the expansion and not seeing any benefit from it. If the veto can be overridden, then we will see our money come back to our area. but please, keep your head in the sand if you choose.

Brock Masters 4 months, 3 weeks ago

Andrea KS already gets back all of the federal dollars it pays so you're not stating a correct reason to expand Medicaid. There may be lots of good reasons to do it but when you start with an incorrect statement you lose credibility.

How many Kansans have died on a waiting list. Numbers will bolster the need for Medicaid expansion so please provide them.

Apparently I am not as knowledgeable as some so please help me understand how the expansion would keep people from going to crummy nursing homes.

I thought people with a disability were already eligible for Medicaid? Am I wrong or are you?

Look forward to the numbers of people dying. I will share it. Also please provide the source because I don't want people thinking I am making up stuff when I share it.

Andrea Zuercher 4 months, 3 weeks ago

The Medicaid program in Kansas now is so stingy that even people who are eligible for services have to get on years-long waiting lists to receive them. This includes disabled adults and children, and elderly people needing the kinds of services Medicaid pays for. I don't have the statistics in front of me, but here's a news story describing what I'm talking about: http://www.npr.org/sections/health-shots/2016/11/16/499563857/to-get-disability-help-in-kansas-thousands-face-a-7-year-wait Here's another link regarding waiting lists: http://www.kidswaivers.org/states/ks

I'm not sure most people are aware that in Kansas, the income eligibility level for Medicaid is people earning 38% of the federal poverty level. In 2017 the federal poverty level for a family of four is $24,300. My "alternative facts" calculator says that's an income of $9,234. Let me know how well you'd do feeding your family if you earned that amount, much less getting needed medical care. If Kansas expanded Medicaid, the income eligibility would jump to 137% of the federal poverty level.

Sorry, forgot one: keeping elderly people out of crummy nursing homes. https://www.kdads.ks.gov/commissions/home-community-based-services-(hcbs)/program-list/frail-elderly Programs like the one in KS are partially supported by federal funds through the Administration for Community Living. You might remember hearing about them during the furor over the Meals on Wheels discussion that ensued from the release of Trump's "skinny budget." Something else people might not realize is that Medicare does not pay for long-term care. You pay for it yourself, or using a long-term care insurance policy. If you run out of money and assets, you can qualify for Medicaid. A more generous Medicaid program means that more people can potentially qualify for services that keep them out of nursing homes.

I can't quickly lay my hands on numbers of people in Kansas who die on waiting lists, sorry. I did find a report from Illinois suggesting that 650 people died on a waiting list for Medicaid services for which they were eligible. This happened after Medicaid expansion. So it's quite possible that expanding Medicaid wouldn't keep this from happening.

No system is perfect, but the idea that Medicaid rolls are full of people sitting on their rears and not earning their own money is just not true. I do health policy for a living, but even for people who aren't immersed in this stuff, it's not hard to find impartial information if you want to.

Brock Masters 4 months, 3 weeks ago

As I said, people with disabilities are already eligible. The problem your link described is not eligibility but access to services. How does expanding Medicaid eliminate the waiting list?

You're right about the income limits and that is exactly why they need the Medicaid expansion. The working poor make too much to qualify for Medicaid but not enough to afford health care.

Expanding Medicaid doesn't mean a more generous Medicaid program. It simply means more people based on income are eligible. So expanding Medicaid doesn't help the elderly stay out of nursing homes.

appreciate the reply and I learned more by looking at your links.

Andrea Zuercher 4 months, 3 weeks ago

Thanks. Carol's point below deserves mention here, too. If the expansion covers more "able-bodied" (but still very poor) adults while doing nothing about the waiting lists for people who are already eligible, then it's only part of a solution, and none of the stuff I said up there is really relevant to Medicaid expansion as much as it is a commentary on how stingy our state Medicaid system is.

JM Andy 4 months, 3 weeks ago

CMS allows states to "waive" certain requirements if it can be shown that serving someone in their home would be cheaper than serving them in a nursing facility. These waivers allow people with intellectual disabilities, physical disabilities, autism, brain injuries and the elderly to hire in-home care with Medicaid funds. It has been determined through case law (Olmsted) that waiting lists for these services are illegal. Yet states like Kansas continue to fail to serve those who qualify.

Ramon Romero 4 months, 3 weeks ago

Money does not grow on trees. Our state government gets money through taxes. Brownback's tax cuts have devasted our state government and made Kansas the laughing stock of America.

Fred Whitehead Jr. 4 months, 3 weeks ago

What else did you expect from this dip sh*t jerk of a "governor"?? You who voted for Brownbackwards.........hope you are PROUD AND HAPPY!!

RJ Johnson 4 months, 3 weeks ago

Fed, I am happy. Look at all the money I am saving!!

People need to stop thinking they are entitled to others money and get off their rearends and earn their own money! LOL

Amy Varoli Elliott 4 months, 3 weeks ago

You probably should have stayed in school past 5th grade. Your lack of understand how the government and the tax system actually work is shocking.

Alex Landazuri 4 months, 3 weeks ago

RJ, what money are you saving? you continue to pay federal taxes, which are funding the expansion. so if youre saving money without the expansion, maybe the irs shoudl be paying you a visit for not paying taxes....

Dorothy Hoyt-Reed 4 months, 3 weeks ago

He's probably one of the many who are not paying state income tax, but still uses our highways. Just another moocher.

Phillip Chappuie 4 months, 3 weeks ago

A couple of points. Mr. Johnson, see the part about how many of those estimated 150,000 that would be covered do indeed work but are still too poor for insurance. Google cost shifting health insurance. Another point that is often overlooked or misunderstood, this expansion has about zero impact on HCBS waiver services for disabled folks. This is strictly for the medical insurance for those adults in the gap income wise and have no disability.

Brock Masters 4 months, 3 weeks ago

Let's not forget why we are in this position of having to have states expand Medicaid.

Obama's signature legislation was flawed and part of it was ruled unconstitutional and thus we have to depend on the state's to expand Medicaid to include the working poor.

Maybe people should stop bashing Trump and work to influence him to fix the parts of the ACA that are broken to make it better. Take time out from callin him a Nazi and use that breath to shout how to lower the costs and cover more people.

Chris Bohling 4 months, 3 weeks ago

You're right, and if Trump actually succeeded in laying out the healthcare plan that he claimed to support before the election, I'd be very happy. However, I don't think Trump really has much power to make a difference here. He's played his hand in trying to force through the (terrible) AHCA, and it failed hard.

I've seen others suggest that the Democrats should go to Trump and attempt to work with him on healthcare reform that moves towards single payer. I honestly think Trump himself would go along with this, if only to move closer to "repealing Obamacare" in some way or another, which is the only thing he really cares about - claiming to have "repealed Obamacare" (regardless of what's actually in the replacement legislation).

But I don't think Congress will pass a left-leaning healthcare bill. Ultimately I don't see the Democrats being able to pull enough moderate Republicans into the fold to be able to override the vote of the Freedom Caucus. If anything, I think moderate Republicans are more likely to slide towards the FC's position for fear of getting primaried. So I think any kind of positive progress on "fixing the ACA's problems" is probably dead in the water until the midterms. There are too many factions in House when it comes to healthcare to reach a simple majority.

Carol Bowen 4 months, 3 weeks ago

"...the bill would have provided care to “able-bodied adults” while elderly and disabled Medicaid recipients are on waiting lists for home- and community-based services."

So, now we are hearing that there is a worrisome waiting list for disabled clients.

Dorothy Hoyt-Reed 4 months, 3 weeks ago

Kancare has been one of Brownback's failures too.

Phillip Chappuie 4 months, 3 weeks ago

Let me repeat this again. This medicaid expansion will have no effect on the current HCBS waiting list. Zero. In essence it is a different pot of medicaid dollars. The only thing that will reduce waiting list is when the state increases it's share of that funding in order to increase federal match. So this is why Brownback can only throw out red herrings for excuses.

Michael Kort 4 months, 3 weeks ago

Well, a Scrooge would say " then let them die and decrease the surplus population ! ".

Do the merciless deserve the mercy of the universe ?

Larry Sturm 4 months, 3 weeks ago

A Governor that has stolen 100s of millions of dollars from state coffers needs to have some old west justice, hang him on the state house grounds.

Charles Jones 4 months, 3 weeks ago

What a despicable human being. Brownback cuts funds for the frail and elderly. Then cites their continuing need as a reason to oppose Medicaid expansion. I don't know much about religion. But I do feel sorry for Jesus tonight. For the harm done by those who hold him up as a golden shield.

Mike Riner 4 months, 3 weeks ago

What a shame that the Legislature doesn't have the stones to do what is right! What a bunch of (slang for felines)!!!!

Richard Heckler 4 months, 3 weeks ago

Like most Americans, I am not overly keen on socialism. History shows that it can curb important personal freedoms and stultify entire economies. But it is not inherently evil. And by the way, if you enjoy your 40-hour workweek, with weekends off, you owe those to an earlier generation of socialist-leaning labor leaders who championed that and so much more that Americans now take for granted.

Where is the statistical evidence that private healthcare outperforms national health insurance programs? The United States ranks 37th on health outcomes, according to the World Health Organization, and it has one of the highest infant mortality rates among developed countries, suggesting that socialized medicine may afford better patient care in some situations.

Opponents of the White House healthcare plans deliberately distort the extent of government involvement in such programs, when the only thing to be "socialized" was the so-called public option health insurance plan – and that may be dropped. Doctors and hospitals would remain private. Critics appear to have deliberately polarized public opinion to scuttle President Obama's initiatives.

Meanwhile, members of Congress enjoy "cradle to grave" socialist medical and retirement benefits that outstrip those of the old Soviet Central Committee members.

Many thousands of the poorest Americans and illegal aliens already have access to taxpayer-funded socialized medicine and hospitals through existing Medicaid benefits. One physician tells me that Medicaid recipients get free hospital care plus stipends at taxpayers' expense. Yet tens of millions of working Americans whose taxes subsidize Medicaid have no access to any health insurance of their own.

Particularly lame are the complaints of healthcare critics in the southeastern US who benefit from the regional socialism of the Tennessee Valley Authority, a government-owned-and-operated supplier of electricity for tens of millions.

America's Social Security program is Bismarckian socialism. Medicare, especially with its prescription drug benefit program is socialistic. Government aid to parochial schools is sleight-of-hand socialism.

Socialism's most vocal critics are often beneficiaries of corporate welfare with all its perks: expense account meals, free NFL box seats, free corporate cellphone use. One firm for which I worked held foreign correspondent meetings in Rome, enabling the executives to visit tailors and shop for Christmas presents in Italy. Exploiting US tax codes, corporate America has long enjoyed its own brand of socialism subsidized by taxpayers.

http://www.csmonitor.com/2009/0916/p09s02-coop.html

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