How legislators voted on expansion, and why
At the Hoisington Chamber of Commerce sponsored legislative coffee held Saturday, April 22, at the Hoisington Activity Center, Rep. Troy Waymaster, Dist. 109, and Rep. Tori Arnberger, Dist. 112, were there and answered questions about how they voted on the bill to expand medicaid in Kansas and why.
Arnberger said she voted in favor of HB 2064 at first, because she thought the tax bill passed by the House would mean more revenue coming into the state’s general fund to offset the cost of expansion. But, when the governor vetoed the bill, she opted to uphold that veto and vote against the bill because she felt the state would not be able to afford the extra costs of expansion.
Waymaster said he voted against HB 2064 at first because it was brought as an amendment, and he swore he would not vote for it in amendment form. But, then he met with representatives from Via Christi Health, the Kansas Hospital Association, and the Kansas Dept. of Health and Environment, and was able to determine what the financing of Medicaid expansion would look like. He saw that it would be either budget neutral or budget positive. He added that in 2013, the governor could have expanded Medicaid on his own, but opted instead to leave it in the hands of the legislature to do it. Then, when they did it, he vetoed the bill. That didn’t sit well with Waymaster. In his opinion, the people of Kansas spoke, and the legislature spoke, and he felt that was the best way to move forward. He voted against the veto.
Senator Mary Jo Taylor attended the Ellinwood legislative coffee on Wednesday, April 19, and said she had voted in favor of expansion both times.
Arnberger stated at the coffee that she was aware of the KanCare Expansion forum being held in Great Bend, and that she intended to be there. She was noticeably absent Monday night.
Monday night, a forum organized by The Alliance for Healthy Kansas at the Prince of Peace parish hall sought to inform and provide answers about why it’s important now for Kansas to expand Medicaid now, even as President Donald Trump has sworn to repeal and replace the Affordable Care Act. Several Barton County residents, as well as some from neighboring counties attended.
With some confusion over the starting time of the forum, a number of attendees arrived after the presentation started. Some inquired as they entered if the forum would include Rep. Tori Arnberger, Dist. 114, but were disappointed to learn she was not there. Arnberger voted in favor of expansion earlier this session, but reversed her vote and upheld Governor Sam Brownback’s veto.
David Jordan, Executive Director of the Alliance introduced speaker Sheldon Weisgrau of The Alliance. He argued a popular claim put forth by supporters of Kansas Governor Sam Brownback, that expanding Medicaid would cost the state money it can’t afford to spend. He offered reasons why expansion could help, rather than hinder, the state budget.
Even though the period when the federal government provided 100 percent of the cost of Medicaid expansion has lapsed, and states this year will need to cover five percent of the cost, the savings and revenue that will be generated will offset this cost, he said. Savings would be generated because the current state match of 44 percent of the cost of Medicaid would be reduced to no more than 10 percent, saving more than $60 million in 2019.
In addition, he said, the state receives rebates on prescription drugs, so more people covered would mean more rebates. Also, the state receives a privilege fee on managed care organizations, including the three that administer KanCare, so more people covered means more fees collected. Together, more than $68 million would be generated that isn’t now, according to the organization’s projections.
In addition, more jobs will need to be filled due to the numbers of people who would seek medical care if covered, who are now deferring basic care because they perceive they cannot afford it. The taxes generated from these incomes, along with the other previous points, Weisgrau said, could provide a net positive impact of $73 million to the state in 2019.
Impact on Barton County
Weisgrau shared what Barton County stands to gain if expansion is allowed, noting that there are currently 1,204 uninsured residents who will gain health coverage. The economic impact that new annual health care spending could generate translated to $5,091,716, and part of that because about 32 new jobs would be created.
He introduced Jim Blackwell, CEO of Clara Barton Hospital in Hoisington, who said that in the last year, the hospital had provided $1.7 million in uncompensated care to patients who had no health care coverage.
“That’s a large dollar for a small hospital in a rural setting,” he said. Early estimates, he said, if expansion occurs, could by $630,000 to help offset that deficit. It’s not just a fiscal impact, he said. Hopefully, if patients get medical attention prior to ending up in the emergency room, that could help to drop the costs of health care further, with fewer costly procedures being required.
Julie Kramp, executive director of The Center for Counseling and Consultation, followed Blackwell. She noted that many people have a stigma about getting mental help, and if they perceive they can’t afford it, they don’t come until a crisis erupts, and then law enforcement may be involved.
“By that time, so many other agencies involved at such a higher cost, and a more prolonged and expensive road to recovery as opposed to seeking help and getting help and knowing that you are going to be covered and you’re going to be cared for,” she said.
Another point Weisgrau made earlier, she touched on again. People who don’t have health insurance have a harder time achieving good credit, because extensive medical bills can be overwhelming to their budget. Not having good credit, he said, can make it difficult to get hired, and that continues the downward spiral of poverty. Cramp said this inability to find a job because of bad credit can hamper case management for people recovering from crisis situations.
“Often, if you waited until then, you have a record, and you have issues, and its that more difficult to overcome that hurdle,” she said. “Expanding KanCare, providing these services, will make such an impact on the people that we serve. The number of people who are able to go at the right time and get the right services would increase.”
Most are able-bodied, working
Some people in attendance shared stories about family members and others they know who are not eligible for Medicaid, but make too little money to afford health insurance, so aren’t eligible for subsidies in the Marketplace. Jordan said 87 percent of the people who fall into this category are able bodied and working.
He spoke about Susan Evans, who testified in favor of expansion earlier this year. A self employed housekeeper in Iola, she assumed legal guardianship of her grandchildren. Prior to that, she was qualified to receive subsidies in the marketplace, but she lost her eligibility for subsidies because she didn’t make enough money with dependants to qualify. This left her uninsured at the age of 56, putting herself, her dependant grandchildren, and the elderly mother she cares for at risk.
“This is one of many stories that represent the able bodied people who fall into this category that we are trying to help through expansion,” he said.
Jordan asked attendees to contact their representatives and let them know their thoughts on expansion, as another attempt at expansion may occur during the veto session in May.