Officials across the country have been keeping a close eye on the health reform debate in Congress because all the leading proposals, despite their differences, would mean major changes at the state level and especially so in Kansas where Medicaid eligibility has been more tightly restricted than in all but a handful of states.
Andy Allison, director of the Kansas Health Policy Authority, said “at least” 70,000 additional Kansans would likely be added to the state’s Medicaid rolls under either of the leading reform measures being considered.
H.R. 3200, the leading U.S. House plan, and the so-called Baucus bill being worked in the Senate Finance Committee, each would expand Medicaid coverage to include all adults earning up to 133 percent of federal poverty guidelines. Currently in Kansas, the program admits no childless adults regardless of income and generally is open only to parents earning less than 30 percent of poverty with some exceptions for pregnant women.
The bills also would shift more than 40,000 children and pregnant women currently enrolled in HealthWave into subsidized private coverage plans. HealthWave is a Kansas program open to children in families earning up to 200 percent of poverty, though that threshold is scheduled to be raised to 250 percent on Jan. 1.
The net result, according to Allison, would be a 25 percent increase over current Medicaid/HealthWave enrollment.
The details remain to be settled, but it is possible, Allison said, that Kansas could end up spending less on the programs despite the increased coverage because the federal government would be taking on much or all of the additional cost burden.
“Most of the bills currently under discussion call for the federal government to pick up most of the cost of the new people coming onto Medicaid,” he said. “There are also opportunities for states to save money through reform, including reductions in costs for prescription drugs and redirecting state funds currently used to pay for uncompensated care and the uninsured. Simple implementation would probably reduce state spending in the long run, but there’s a lot of turf to cover between now and the year 2014, when most of the changes would occur. The way these reforms are structured and the question of whether they save the money or cost money may well come down to a series of choices the state itself will have to make.”
Allison said a significant increase in the number of people with health insurance coverage either through a government plan or subsidized private plans would contribute to the problem Kansas already faces of having too few primary care providers.
“Access to care will remain a concern in Kansas even if reforms make that care affordable,” he said. “We are facing a shortage in primary care and oral health services that is especially acute in our rural areas and inner cities. These are critically important pieces of the puzzle. Right now we’re sitting on pause as we wait to see what happens in Congress, but I’m not sure any single set of reforms can answer all the questions we face in health care.”
-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.