By Mike Shields
KHI News Service
TOPEKA, Feb. 26 — With the Legislature at midpoint, the chances of success for the major health care reforms currently on the table seem increasingly dim.
Gov. Kathleen Sebelius in her state of the state speech at the opening of the 2007 Legislature urged lawmakers to craft a plan this year for “universal coverage.” And her GOP challenger in the 2006 governor’s race, Sen. Jim Barnett, R-Emporia, introduced Senate Bill 309, creating a health insurance exchange or “connector” similar to one recently enacted in Massachusetts
. But to date, neither the governor’s nor Barnett’s call to action seems to have garnered much support among rank-and-file legislators or their leaders.
“Universal coverage is a laudable goal, but I don’t see us getting there yet,” said Senate President Steve Morris, R-Hugoton. “ Massachusetts
is the state that’s come closest but they’re having glitches. I’ll be very surprised if any state gets to that goal anytime soon.”
SB 309
Two days of hearings were held on SB 309, but the Senate Public Health and Welfare Committee did not have time to work the bill before the turnaround deadline. The bill is technically alive, having been referred to the exempt Ways and Means committee, but it is opposed by Blue Cross Blue Shield, the state’s largest health insurer and small business groups.
House Speaker Melvin Neufeld, R-Ingalls, said the GOP caucus in his chamber is still interested in the connector concept, but would never accept SB 309 as is because it includes an individual mandate.
“The individual mandate kills it in the House,” Neufeld said.
Many supporters of the connector concept say it cannot work without the mandate
Governor’s Healthy Five
Even the governor’s more-specific, but less-ambitious
plan to expand HealthWave coverage
to another 2,000 children ages 5 and under seems on shaky ground. The House rejected that plan last year with no indications it is friendlier to it this year.
“Zero-to-five is probably going to be difficult in the manner the governor has presented it,” said Rep. Bob Bethell, R-Alden, chairman of the House Appropriations social services subcommittee. “Going to 300 percent of poverty puts a family of four making $62,000 annual salary into getting a state benefit.
“There needs to be a 0-to-5 program for those kids who are in need of care, but we need to be very careful of who we bring into that so we don’t take them off of private insurance, so we don’t make the state responsible for something they could pay for but chose not to.”
And in the Senate there seems to be more interest in enrolling more of those currently eligible for HealthWave in the program than in expanding the eligibility parameters, which is what the governor and the
Kansas Health Policy Authority
have proposed doing.
Studies show that between 66 percent and 71 percent of uninsured children are eligible for Medicaid or HealthWave coverage but are not enrolled.
Morris said there’s “a lot of interest” in the Senate for doing more to boost enrollment.
Sen. Laura Kelly, D-Topeka, a member of the Senate Health Task Force, is among those who would like to see that happen. Like Morris, she said she’s wary of passing something as sweeping as Senate Bill 309, which would mandate every individual have health insurance until its ramifications are fully understood. She said she’s strongly interested in enrolling more currently eligible children in HealthWave, without expanding eligibility.
“That’s something we can do,” she said, “capture the kids who are out there but not enrolled. I think Kansas Health Policy Authority has a handle on how to do that. That would be a very high priority for me.”
The health policy authority had asked for $441,636 from the state general fund; $882,272, all funds, to hire eight outreach workers and equip them with laptop computers and an online screening tool. The request also included $100,000 for marketing. But the funds did not make it into the governor’s budget.
“They didn’t give us a rationale why (the KHPA proposal) would bring more children in.” said Julie Thomas, a Budget Office analyst when the budget was unveiled in January. “And we thought it ought to be a part of what KHPA is already doing.”
Other shoe to drop
Next week, according to Neufeld, the House GOP task force on health care will unveil its plans for health care reform. The task force, appointed by Majority Leader Ray Merrick, R-Stillwell, has been chaired by Rep. Jeff Colyer, an
Overland Park
plastic surgeon. No details about the plan were available when lawmakers left the Statehouse on Friday, but “affordability and portability is the emphasis we’d like to put on it,” Neufeld said. “There will be a House plan like no one has seen before.”
It seemed likely the plan would include at least some element of a connector or exchange since Neufeld has said he likes the idea of a “fiscal agent” that allows individual premium payments to be tax deductible. It also is likely to include a component that would take advantage of new flexibilities afforded states in Medicaid spending by the federal Deficit Reduction Act. Among those: the ability to charge premiums and introduce co-payments for non-emergency services provided in an emergency room. The Deficit Reduction Act also allows states to use Medicaid or SCHIP money to pay for employer-sponsored health insurance. The House GOP plan likely will also include two or three initiatives or bills already in the works including
one that would expand newborn screening.
Also in the coming days or weeks, the Health for All Kansans Task Force is expected to complete its list of policy recommendations for the Legislature to consider. But those recommendations are not expected to hold much sway coming late in the session.
Setting the stage
Some predict this session will have been one in which the stage was set for major changes down the road.
“I do think the health care issue will dominate the next two or three years until we come up with a plan,” Sen. Kelly said.
As for the governor’s call for a plan for universal coverage this year: “I think the governor’s pretty pragmatic,” Kelly said. “You do what you can to put the pieces in place very carefully for a vision and a path, but with no real expectation” it will happen in a year. “Everything here takes longer than you think.”
Mike Shields is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at mshields@khi.org or at 785-233-5443, ext. 123.