photo by: Nick Krug

Kansas Statehouse in Topeka, February 2014.

Story updated 4:35 p.m. Tuesday, Oct. 2:

TOPEKA – Mercy Hospital in Fort Scott announced Monday that it will close its doors by the end of the year, a move that is already reigniting debate in Kansas over expanding the state’s Medicaid system under the federal Affordable Care Act.

The closure of the Fort Scott hospital comes three years after another hospital, which was owned by the same St. Louis-based health care system, closed its doors in Independence, Kan.

In their announcement, Mercy Hospital officials cited a number of factors that led to the decision, including a large number of patients leaving the area to seek health care in larger communities.

But the hospital also cited “declining reimbursement, especially from government payers which make up the largest source of revenue.”

“We considered — and exhausted — every possibility for keeping our doors open, and ultimately we had to acknowledge that it’s a different era for hospital care in Fort Scott,” hospital president Reta Baker said in a news release.

Nancy Corbett, a spokeswoman for the Mercy hospital system in St. Louis, said in an email, “The lack of Medicaid expansion in Kansas was a contributing factor to the hospital’s financial challenges.”

Founded in 1886, Mercy Hospital Fort Scott is a 46-bed acute care facility that employs 307 people. The town of about 7,800 people, in Bourbon County, is about 80 miles south of Olathe and about 35 miles north of Pittsburg.

Officials at the Kansas Hospital Association, however, were quick to point to the state’s refusal to expand its Medicaid program as a significant factor.

“One common thread in Kansas is our state’s failure to take advantage of KanCare expansion,” KHA said in a statement. “Since the opportunity initially arose, Kansas has left more than $2.8 billion on the table that could have gone toward strengthening access to health care in our state.”

KanCare, the state’s privatized Medicaid program, currently covers about 400,000 low-income families, elderly and disabled individuals. It does not cover childless adults, and the income limit to qualify for the program is $770 a month for a family of four.

Under the Affordable Care Act, also known as Obamacare, states are allowed to expand their programs to cover any individual with income up to 138 percent of the federal poverty level, or $2,887 a month for a family of four. That would extend coverage to an estimated 180,000 individuals, with the federal government paying at least 90 percent of the cost of covering those newly eligible individuals.

Since the ACA’s inception, though, Republican Govs. Sam Brownback and Jeff Colyer have opposed Medicaid expansion. In 2017, Kansas lawmakers passed a bill to expand it anyway, but Brownback vetoed that bill and the House was unable to override that veto.

But the announcement of the Fort Scott hospital’s impending closure, just five weeks before the Nov. 6 general election, is sure to put the issue back on the table.

In the race for governor, Democratic candidate Laura Kelly and independent candidate Greg Orman have both said they favored Medicaid expansion, while Republican candidate Kris Kobach has said he opposed it.

“This should not have happened,” Kelly said in a statement Tuesday. “Simply put: if Kansas had expanded Medicaid, Fort Scott would still have a hospital.”

The Kobach campaign, however, said he did not think Medicaid expansion would have saved the hospital.

“The health system lost tens of millions of dollars over the last few years, and expansion wouldn’t come close to making up the difference,” Kobach spokeswoman Danedri Herbert said in an email. “It would have only served to stick Kansas taxpayers with a larger bill.”

The key, though, will be whether there are still enough votes in the Legislature to pass such a bill after the November elections.

“We’ve never stopped pushing for Medicaid expansion,” House Minority Leader Jim Ward, D-Wichita, said in a phone interview. “Medicaid expansion is one of several pieces that would improve health care in Kansas.”

In addition to this year’s House races, there is also a special Senate election in the 13th District, which includes Fort Scott, in southeast Kansas. There, incumbent Sen. Richard Hilderbrand, R-Pittsburg, who was appointed to the seat in 2017, is running for the right to fill out the remainder of LaTurner’s term.

Hilderbrand faces a challenge from Democrat Bryan Hoffman, of Mulberry, who issued a statement Monday saying he supports expansion.

“Expanding KanCare must be made a priority to protect the remaining community hospitals and clinics in Southeast Kansas and across our state,” Hoffman said in the statement.