A community conversation on health care and the Affordable Care Act in Kansas covered a wide range of topics, and the discussion in the Kansas Legislature is beginning to open up as well, said Jim McLean of the Kansas Health Institute News Service.

“It’s been amazing how this issue has been bottled up the last two years,” McLean told the about 100 attendees of the event at the Lawrence Public Library on Sunday. “But people who oppose it recently are starting to realize we need a better answer than just ‘no.'”

McLean and Sandy Praeger, former Kansas insurance commissioner, led the conversation, titled “Straight Talk about Kansas Health,” that included discussion of the implementation of the ACA and the hesitancy to expand Medicaid in Kansas, as well as health-focused programs in Lawrence.

Sandy Praeger

Jim McLean

McLean said that for the past two years, the discussion of expanding Medicaid in Kansas has been largely political, with those in opposition having the legislative and executive power to say no without further consideration. But with the threat of hospital closures looming — demonstrated by the closing of Mercy Hospital in Independence this month — the nature of the discussion is changing.

“We’re starting to have a better debate,” he said.

Currently, the Medicaid program in Kansas covers mainly low-income children and families, seniors and disabled individuals. For families with dependent children to qualify, the income limit is about one-third of the federal poverty level, or $9,216 a year for a family of four. Working-age adults without children cannot receive Medicaid in Kansas. Under the ACA, states can extend Medicaid to all individuals with incomes up to 138 percent of the poverty level, or $32,913 a year for a family of four.

Praeger said people without health insurance, partly because of the lack of expansion of Medicaid, is the biggest health issue facing Kansans. Changing the qualifications would offer health insurance to more people and help to close the “Medicaid gap,” that has left some relying on only emergency care.

“Going to the emergency room is not access to health care,” she said. “That’s sick care.”

Kansas is one of 20 states not expanding Medicaid. McLean agreed that the lack of expansion is creating state-to-state disparities in access to health care.

“When you plot that out on a graph — the extent to which the percent of uninsured has gone up or down — it’s really creating two countries,” he said.

Alternatives to the ACA were also discussed, such as a single-payer system similar to Social Security or allowing insurance policies to be sold across state lines. One component of the ACA that has brought some complaints, the individual mandate, is necessary to keep health insurance accessible for everyone, McLean said.

“In the old system, it was more difficult for people with pre-existing conditions to get a policy,” he said.

But measures taken on the state level aren’t the only way to improve the health of Kansans, they said. Both speakers commended efforts being made in Lawrence — such as Safe Routes to School, Community Village Lawrence, LiveWell Lawrence and BackSnack — that work to improve health locally for people of all ages.

“Health really does reside at the community level, and people really can do an awful lot,” McLean said.

Praeger said that apart from those initiatives, there are also things individuals and local organizations can do. Individuals can be sure to keep their hedges trimmed near sidewalks to keep pathways clear and grocery stores and schools can ensure that fresh fruits and vegetables are available, she said.

“A community is there to make sure some of those health care services may not be needed,” Praeger said.