By Mike Shields and Jim McLean
KHI News Service
TOPEKA, Feb. 19
The Health Care for All Kansans Steering Committee met for 90 minutes Monday, quickly narrowing
a list of 28 reform proposals
to seven.
But it wasn”t clear if that short list will survive another meeting of the panel put together to guide the Legislature as it seeks a possible course on health care reform in a session that has seen proposals and committees to study them sprout like mushrooms after a spring rain. There are no fewer than a half dozen committees and task forces studying more than three dozen plans or bills.
Also on Monday, hearings on the most far-reaching proposal to date, Senate Bill 309, began and will continue into Tuesday. That bill would require every Kansan to purchase private health insurance through a state-administered “exchange” or “connector” or post a $10,000 escrow. It is similar to a reform underway in Massachusetts, though it does not include a subsidy for those who might have difficulty affording the insurance or a requirement that employers participate.
Three tiers
At the steering committee meeting, members reviewed 28 proposals ranked in three “tiers” by Kansas Health Policy Authority executive director Marcia Nielsen.
Nielsen listed 10 proposals as Tier One, meaning in her view they were items of “general consensus.” Tier One included items such as adding an inspector general for the Medicaid program and expanded marketing and outreach for
HealthWave.
Not included on that Tier One list was the governor”s so-called Healthy Five plan, which would expand the HealthWave program to children ages 5 and under whose families earn 300 percent or less of federal poverty guidelines. That plan was rejected by the House last session but emerged again this year as Gov. Kathleen Sebelius” top health care priority. Nor did Nielsen”s Tier One list include SB 309, the brainchild of Sen. Jim Barnett, R-Emporia, Sebelius” GOP opponent for governor last year. Each of those still controversial plans or their close approximations were assigned by Nielsen to Tier Two, meaning in her view they had “developing consensus.”
At the suggestion of committee member Joe Tilghman, who also is a member of the health policy authority board, the committee winnowed Nielsen”s list to seven proposals mostly pulled from the Tier Two list, including the governor”s Healthy Five plan and Barnett”s connector minus the mandate that individuals participate. The mandate had been decoupled from the connector and pushed to Tier Three, the category for items for which sufficient data was lacking or for which consensus was “limited.”
Among the Tier Three items was a proposal for promoting the importance of health insurance to Hispanics. Studies show that 17 percent of the state”s uninsured are Hispanic.
Nielsen called the Tier Two list the “sexy stuff,” but cautioned members that “what we want is momentum to get something done this session.”
But Tilghman urged fellow committee members to not adopt recommendations that invite more studies or bureaucratic wrangling or might already be reasonably expected to be accomplished without the committee”s endorsement.
“Somehow in the last six months the stars got in alignment for people to pay attention to health issues,” he said, “and we”ve got a wonderful opportunity” to push for expanded health care access.
The short list
Other items on the committee”s short list:
*
Premium assistance, using Medicaid or SCHIP funds to subsidize families that want to purchase private insurance but otherwise could not afford it.
*
Pursuing Deficit Reduction Act flexibilities or waivers under the federal law to put together benefit packages and reform models, the bottom line being to pull in more federal dollars. In conjunction with SB 309, for example, this would be a way to use Medicaid dollars to help poor families purchase private insurance.
*
Expand insurance through their parents” policies to young people up to age 25. Current law allows children to be on their parents” policies only to age 23.
*
Create a health insurance exchange.
*
A reinsurance program similar to Healthy New York to reduce premium volatility in small group costs. The aim being to expand coverage to small employers and sole proprietors.
*
Expanded newborn screening
.
The committee agreed to go back over the list after staff from the health policy authority paired each recommendation with an analysis of what segments of the uninsured population each proposal would likely benefit. Serious questions were raised by some committee members about several of the items, so it was far from clear the short list would survive intact that second round of review.
SB 309 hearings
Simultaneous with the steering committee”s work, hearings began in the Senate Public Health and Welfare Committee on SB 309.
There, Barnett urged fellow committee members to move forward with the bill.
“It is insufficient to say that we want to deal with that issue (the uninsured) and not offer some kind of plan, some kind of roadmap to get there,” he said. “We”ve got to have some leadership. We”ve got to have some idea of how to get there.”
He estimated SB 309 would substantially reduce the number of uninsured Kansans, particularly those who lose coverage when switching jobs.
“How much, probably half,” he said.
An estimated 300,000 Kansans lack health insurance at any given time.
Barnett said a key to solving the problem was getting people into private coverage through the connector and through Medicaid waivers that would allow the state to subsidize the purchase of private insurance for low-income families.
The committee also heard from Charles Wheelen, lobbyist for the Kansas Association of Osteopathic Medicine. He testified in favor of the bill. The hearing resumes at 1:30 p.m. Tuesday at the Statehouse, Rm. 231-N.
A date has not yet been set for the next meeting of the Health for All Kansans Steering Committee.
Mike Shields and Jim McLean are staff writers for KHI News Service, which specializes in coverage of health issues facing Kansans. They can be reached at 785-233-5443.