What a ruckus! And look who paid for the oppostition.


Kansas is considering Medicaid expansion which is a portion of the Affordable Care Act (ACA) the US Supreme Court made optional in 2012. Twenty-two states have (until now) opted out of Medicaid expansion. Kansas and Missouri are among those states.Without the Medicaid expansion which was designed as part of the ACA about 300,000 Missourians, and about 150,000 Kansans make too much to qualify for Medicaid, but not enough to qualify for the subsidies offered by the Affordable Care Act. Their employers offer them no health coverage.


The hearing in mid-March, 2015 on Kansas House Bill 2319 (which will simply remove legislative brakes on Medicaid expansion in Kansas and return the issue to the executive branch) had more than 150 proponents and fewer than 10 opponents.


Interesting- the opponents all have ties to David and Charles Koch. Two spoke from Americans for Prosperity (a Koch brothers agency from DC and recently associated with the defeat of Medicaid expansion in Tennessee), one from Kansans for Liberty (also a Koch supported group), and one from the Kansas Policy Institute (also a Koch group). Akash Chougule, a national representative for Americans For Prosperity, testified that AFP would hold accountable any lawmaker who voted for expansion. Historically politicians who oppose the Koch Brothers have had costly dirt thrown at them during their campaigns. The current Secretary of Health for the Governor of Kansas also spoke against the bill.


More than 150 proponents presented verbal and written testimony from a broad base of health providers, concerned citizens, business, religious and advocacy groups. The Kansas Medical Society, the Kansas Hospital Association, Chambers of Commerce from several cities and other independent organizations spoke and wrote in support of passage of the bill and for passage of Medicaid expansion. A very different group of supporters from the few paid opponents.


Sharon Lee 


The New York Times

Medicaid Expansion in Red StatesShare



March 16, 2015


A number of states that had previously refused to expand their Medicaid programs for the poor are reconsidering that policy. They would be smart to embrace expansion as soon as possible to cover millions of people who would be left uninsured if the Supreme Court wipes out federal subsidies for low-income people buying insurance on the federal health exchanges.


The Affordable Care Act originally required all states to expand Medicaid to cover people with an income up to 138 percent of the federal poverty level, or $32,913 for a family of four, but in 2012 the Supreme Court made expansion optional. Twenty-eight states and the District of Columbia have expanded their programs, but 22 have not.

The federal government pays 100 percent of the costs of covering newly eligible people through 2016, shifting down to 90 percent in 2020 and future years. This is a huge benefit to the states, since more health coverage means a healthier population, fewer people losing jobs because of health crises, greater productivity at work, fewer people getting charity care at costly hospital emergency rooms, and less strain on hospital and clinic budgets.


States that have not expanded Medicaid say it will strain them to pay even 10 percent of the costs. They insist that if the federal government pulls back from paying 90 percent, they will have to pick up more of the tab — but there is no reason to believe that will happen, and if it does, it can be resolved when it arises.

Fortunately, more and more Republican governors support expansion. Michigan, Ohio and Indiana are among 10 states with Republican governors that have already expanded Medicaid in recent years. Indiana and Iowa used Medicaid dollars to pay premiums for private health plans for poor people, an approach that requires federal approval and under federal rules must be budget neutral and offer comprehensive coverage.



Other pragmatic Republican governors, however, have been wrestling with Republican-controlled legislatures that cannot see the folly of refusing to take the federal money.


In Kansas, Gov. Sam Brownback, a Republican who was previously a staunch opponent of expansion, recently said he was not opposed to an expansion that was “100 percent paid for” but wanted the Legislature to approve it. There are good reasons to do so. Kansas has a stingy Medicaid program that covers adults with children only if they earn no more than 38 percent of the federal poverty level, or $9,215 for a family of four, according to the Kaiser Family Foundation. A study sponsored by the Kansas Hospital Association estimated that the state’s failure to expand Medicaid in 2014 and 2015 is costing it $714 million in federal funding and 3,400 jobs in 2015.


In Florida, Gov. Rick Scott, a Republican, initially opposed expansion, then came out in favor of a three-year expansion to judge how well it works. After facing bitter criticism from Tea Party activists, he did not make it a priority. The Legislature ultimately rejected expansion but is now reconsidering. The more moderate Senate is considering a bill to use federal dollars to buy private insurance, but the more conservative House seems unlikely to endorse any expansion.

Alaska’s governor, a former Republican turned Independent, has proposed expansion, but Republican legislative leaders are balking. In Tennessee, a Republican governor worked hard on an expansion plan only to have it killed in February by the Legislature, which had been lobbied heavily by conservative groups.

In Utah, where the Republican governor has proposed an expansion plan, the Republican-dominated Legislature adjourned Thursday night without taking action, though the governor and legislative leaders agreed to negotiate a plan that could be approved later. In Wyoming, the Republican governor originally opposed expansion but changed his mind only to have expansion bills die in the Republican-controlled Legislature.

Not surprisingly, Democratic governors who favor expansion, like those in Missouri and Montana, have also been stymied by Republican-controlled legislatures.

The ideological gridlock in so many state capitals is inflicting serious harm on state budgets. But the greatest losers are poor people who cannot afford health coverage and the hospitals and providers who will have to take them on as charity care.


Former Brownback cabinet secretary testifies for Medicaid expansion

Robert Moser headlines list of 150 expansion proponents from business, medical and religious realms

By Andy Marso | March 18, 2015           

Former Brownback cabinet secretary testifies for Medicaid expansion Photo by Dave Ranney Robert Moser, former secretary of the Kansas Department of Health and Environment, testifies for Medicaid expansion Wednesday.

Robert Moser, who until December was the secretary of the Kansas Department of Health and Environment, headlined a long list of Kansans asking legislators Wednesday to expand Medicaid.

In a long-awaited and much-anticipated hearing in the House Health and Human Services Committee, Moser urged legislators to look past dissatisfaction with the federal Affordable Care Act (ACA) and consider the practical implications of continuing to refuse expansion and the federal dollars that come with it.

"Expansion is critical for Kansas," Moser said. "Our providers need it. Our people need it."

Wednesday's hearing concerned House Bill 2319, which would compel Gov. Sam Brownback and KDHE to develop an expansion plan and negotiate with federal officials for its approval.

Proponents of the bill testified Wednesday and opponents were scheduled to testify Thursday.

Wednesday's hearing brought a standing-room only crowd that spilled out to the hallway of the Statehouse's fifth floor, where custodial staff brought in extra chairs to accommodate the overflow.


Photo by Dave Ranney Marcillene Dover, a Wichita State University student with multiple sclerosis, testifies while Moser, left, listens.                


Testimony in favor of expansion came from more than 150 health care providers, business organizations, religious leaders and activists like Finn Bullers, a Prairie Village man with muscular dystrophy , and Marcillene Dover, a Wichita State University student recently diagnosed with multiple sclerosis.

Dover said there was a delay in getting her symptoms diagnosed correctly because she did not have insurance and could not afford an MRI.

“I thought ‘No way, not me, I don't have a disease. I'm 21, in the prime of my life,’” Dover said. “I didn't have insurance. Just to get diagnosed would be extremely expensive.”

Dover gets her expensive medications and neurological treatments through a patchwork of charity and public health groups. She asked the committee to think about others who are uninsured and don't have those connections.

"No one should have to go through receiving a devastating diagnosis and then feel further devastation having to figure out how they're going to pay for the health care they need," Dover said.

"Expansion is critical for Kansas. Our providers need it. Our people need it."

- Robert Moser, University of Kansas Hospital physician and former secretary of the Kansas Department of Health and Environment

A binder with hundreds of pages of written testimony was compiled by the Kansas Hospital Association, the organization that has taken a leading role in pushing for expansion because of its financial benefits to the state's hospitals.

The ACA cut Medicare payments to hospitals on the assumption that expansion of Medicaid would make up the lost revenue. But the 2012 U.S. Supreme Court decision upholding the ACA also said that states could opt out of expansion, and about half the states — all controlled by Republican legislatures — have done so.

Kansas’ privatized Medicaid program, KanCare, covers about 425,000 children and low-income, disabled and elderly adults. But that number includes relatively few non-disabled adults.

Adults with dependent children can participate in KanCare, but only if they have incomes below 33 percent of the federal poverty level, or a little more than $8,000 annually for a family of four. Adults without children aren’t eligible for coverage no matter how poor they are.

Expansion would make all Kansans with incomes up to 138 percent of poverty eligible for KanCare. The eligibility cap would be set at annual income of $16,105 for an individual and $32,913 for a family of four. Estimates vary, but it’s thought Medicaid expansion would extend coverage to between 140,000 and 170,000 Kansans.

"With one stroke, you could reduce the number of uninsured in this state almost by half," Jerry Slaughter, executive director of the Kansas Medical Society, told legislators.


Photo by Dave Ranney Tom Bell, president and CEO of the Kansas Hospital Association, told legislators expansion would be an economic boon to the state.



Recently, some Republican governors have negotiated with the federal government for expansion plans intended to allay conservatives’ concerns about cost and government growth. Tom Bell, president and CEO of the Kansas Hospital Association, said HB2319 gave the Brownback administration the opportunity to do the same.

“This is a way to build on the current privatized Medicaid program in a way that supports the economy, in a way that's fiscally responsible, in a way that promotes personal responsibility and in a way that provides person-centered care for thousands of people who do not have it,” Bell said.

The hospital association released a study in 2013 that found accepting expansion and its federal dollars would spur $3 billion in economic growth and 4,000 new jobs by 2020.

Rep. Jim Kelly, a conservative Republican from Independence, said Medicaid expansion was not “high on his list” of things to do, until he started hearing from hospitals in his mostly rural district that are struggling mightily.

“We have one very stressed hospital,” Kelly said. “We have another that's probably not at the same level but certainly not good.”

Kelly said he’s concerned about facilities closing in part because of the failure to expand Medicaid.


Photo by Dave Ranney Rep. Don Hill, a Republican from Emporia; Rep. Jim Kelly, a Republican from Independence and Rep. Susan Concannon, a Republican from Beloit, listen to testimony Wednesday.             


Brownback and legislative leadership have thus far made no move to expand Medicaid, but Moser said Wednesday that now is the time.

Moser, a physician, now heads a heart attack and stroke unit at the University of Kansas Hospital. 

He said the hospital had lost about $10 million in Medicare reimbursements per year since the ACA passed and is now absorbing about $60 million per year in uncompensated care. 

“Not all of that is charity care, but with the KanCare expansion model being proposed, we believe we can cut charity care costs by 30 percent,” Moser said.

Moser said that while he was speaking on behalf of KU Hospital, his support for expansion “goes beyond hospital interests.” As one of the architects of KanCare, Moser said the program was increasing primary care for those on Medicaid, keeping them out of emergency rooms and improving their health at lower costs.

He emphasized that expansion would help Kansas’ working poor.

“The vast majority of those in the expansion population are hard-working people, some working multiple jobs,” Moser said. “The trouble is, they are not benefits-eligible at any of those jobs.”


Photo by Dave Ranney Steve Kelly, president and CEO of Newton Medical Center, talks with Concannon after Wednesday's hearing.



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Link to this report from the Kansas Health Institute.