By CRISTINA JANNEY
Lt. Gov. Lynn Rogers said Medicaid expansion is not just an economic issue, it’s a moral issue, as he made a stop at HaysMed Tuesday morning for a discussion on health care.
Medicaid expansion legislation has passed in the Kansas House, but has yet to pass in the Senate. Medicaid expansion was a central piece of Rogers’ and Gov. Laura Kelly’s campaign platform.
In Ellis County, Medicaid expansion would insure 731 more residents, create 20 new jobs and have an economic impact of almost $4.9 million.
Rogers, as well as local health care professionals, gathered for a group discussion. The majority agreed Medicaid is needed to provide preventive health care for rural Kansans and maintain rural hospitals and health care clinics.
“We know Medicaid expansion won’t necessarily save a hospital, but we know it is one of the major indicators that has created problems,” he said.
About 30 Kansas hospitals are on a very vulnerable list, two rural Kansas hospitals have closed in the last 45 days, and two more have closed in the last year.
“Really what this does is Medicaid expansion takes 150,00 Kansans away from the highest cost medical service — emergency care— and puts them into preventive care, where they can have many of their services paid for in advance,” Rogers said.
“We see it as a very budget neutral situation now that we have a $25 per person per month fee and what it saves us in other state agencies it could really mean some really good things for the state of Kansas.”
The fee for families for Medicaid expansion would be capped at $100. These fees would generate about $20 million to $25 million of the $30 million cost to the state of Kansas for Medicaid expansion. The federal government currently pays 90 percent of Medicaid expansion. The House bill also stipulates if that federal match would be eliminated, the state would end Medicaid expansion.
Walt Hill, executive director of High Plains Mental Health, said Medicaid expansion would be a great boon to preventive mental health care. High Plains sees 6,000 patients per year in its coverage area. Out of a $10 million budget, $1 million a year is services provided to the uninsured.
“We have to find alternative sources of funding,” Hill said. “We often provide services on the backs of our staff who are very difficult to recruit and retain in the area.”
Rogers said in looking at mental health services in the state, the Sedgwick County jail is the third largest provider of mental health services only behind the two state mental health hospitals.
“We as taxpayers are spending $10 to $12 million on mental health services that probably would be covered under Medicaid,” he said.
Rogers and Hill both noted competition is high for health care recruiting. As Nebraska expands Medicaid, there is concern that qualified health professionals will continue to move out of state for more competitive wages.
Edward Herrman, HaysMed CEO, said although the amount rural hospitals would receive from Medicaid expansion doesn’t seem like much, it may be the difference between those hospitals breaking even.
“I can tell you that we know for sure that there are a few facilities that even if it is only $100,000 or $150,000 in benefit they would see, that is literally what they are missing in having a margin. …
“There are more people in the larger areas, but the actual impact is much larger in the rural areas. $100,000 in bottom line revenue means a heck of lot more to a Rush County hospital than $1.5 million on the bottom line for a St. Francis or the University of Kansas hospital.”
Herrman also noted during polls, three-quarters of Kansans said they are in favor of expansion.
Kansas is one of 14 states that has not expanded Medicaid. Kansans pay taxes to support Medicaid expansion, but the funds go to other states, he added.
“Most importantly, it is 150,000 Kansans who are falling in the gap and we are not even providing basic primary care for them,” Herrman said. “They do end up showing up in our ER in the most expensive place you can possibly receive care as well as many times not the appropriate place to receive your care.”
Bryan Brady, First Care Clinic CEO, said the clinic takes care of about 7,000 patients — 1,600 of those are uninsured. The clinic estimates about 1,000 of those patients would qualify for health insurance under Medicaid expansion.
“That would mean about $400,000 to our facility directly,” he said. “That is a huge amount. What we do is keep those patients out of the emergency room — the most expensive method of care.”
Dr. Heather Harris, family medicine provider with HaysMed, said a lack of insurance results in individuals waiting to get care until a health problem is acute and costs more to treat.
“Not only do they not come in for acute things, but they wouldn’t dream of coming in for anything preventive,” she said. …
“They come in late. They can’t afford the medicines. We have trouble giving them the education they need about food and exercise and smoking. If you can treat the parents, you can hope you will have healthier kids. It is just this continued trend. You can barely get them well for their acute things. You are never going to get them preventive care.”
Rogers said keeping people healthy, productive and employed benefits the state of Kansas.
First Care Clinic Medical Director Christine Fisher said Medicaid expansion would help the working poor.
“These are productive people, God help them, who are trying really hard, but they just need that extra bit of help that will make them even more productive members of society,” she said. “By making them healthier, you will only increase productivity and what you gain from the health care aspect will be very far reaching. If you give a person insurance, they will get their preventive care done, and if you don’t, they simply will not.
“If you don’t do primary care and preventive care, health care is extremely expensive down stream.”
HaysMed Cardiologist Dr. Jeff Curtis described himself as a “red doctor,” but he said he supports Medicaid expansion as a people issue and a patient issue.
“In the short term, I am in favor of Medicaid expansion, not just for our hospital, but for everything in western Kansas. It is a Band Aid until we can figure something else out. If we don’t get it and we don’t have it and we see all the other states around us getting it, that means people in our state are suffering.
“If we have it, we can expand the services in our bigger hospital — new equipment and new services — so patients don’t have to go to Kansas City, Wichita, Denver or Kearny. It helps us attract high quality health care workers, which is a challenge out here.”
“We need it to survive,” he added.