By Mike Shields
KHI News Service
TOPEKA, June 19
An increase in tobacco taxes is a good idea, members of the Kansas Health Policy Authority agreed Tuesday as they signed off on steps for crafting a major health care reform plan.
“From a public health perspective, we know these things (tobacco taxes) have deterrent value,” said Dr. Howard Rodenberg, noting that a tax increase could help pay for the plan while also discouraging smoking.
The health policy authority has been tasked with delivering a reform plan to the Legislature and governor by November for possible action by the 2008 Legislature.
Tuesday, board member Joe Tilghman, also a member of the authority”s Health for All Kansans Steering Committee, outlined a “roadmap” for developing the reform plan, which will be written with contributions from four advisory committees meeting off and on throughout the summer and early fall. Fellow board members, with no dissent, endorsed Tilghman”s roadmap which the advisory councils will be asked to follow as they discuss and develop their contributions to the reform plan.
Gov. Kathleen Sebelius, a Democrat, proposed a tobacco tax increase in 2004 to pay for expanded health care coverage but the idea was rejected by the Republican-dominated Legislature. She said at the end of the last legislative session that she thought lawmakers might now be more willing to accept an increase, if it were linked to a comprehensive health reform plan and that she also was willing to reconsider it.
In addition to a tobacco tax increase, board members agreed the councils should be asked to consider and include in their reform plans:
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Requiring some small employers to offer health insurance for workers.
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Creating a “trust fund” or dedicated revenue source to help finance universal health care coverage so that the Legislature would be less likely to reallocate the dollars to other programs.
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A basic benefit package within the universal plan that would require those earning between 100 percent and 250 percent of federal poverty guidelines pay no more than 10 percent to 12 percent of their annual income in premiums with the balance to be subsidized by the state and federal governments.
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Programs for preventing and treating obesity and tobacco use.
Also, Marcia Nielsen, executive director of the health policy authority, told board members that the agency has received $250,000 in grants to pay a consultant to do “economic modeling” for the proposed reform plan; including $100,000 from the Sunflower Foundation and $100,000 from the United Methodist Health Ministry Fund. She said the agency still needs an additional $50,000 in grants to pay the consultant.
The harshest criticism of Tilghman”s proposed roadmap came not from board members but during public comment.
Scott Day of Day Insurance Solutions, Topeka, warned the board that mandating participation in a universal coverage plan by employers or individuals would be unpopular in Kansas.
“We have a vibrant market already in place,” he said. “Ninety percent of us already have health insurance and are not going to be for this. Kansans are not going to warm to employer mandates or individual mandates.”
That position also has been staked out by many legislators, including House Speaker Melvin Neufeld, R-Ingalls.
HealthWave update
It was a day-long meeting that touched on many topics.
The agency”s Medicaid director, Andy Allison, told board members that the U.S. Senate Finance Committee was expected to begin mark-up of the SCHIP reauthorization bill later this week or early next week
“We run into trouble about next summer,” if Congress fails to reapprove the children”s health insurance program to cover all children up to 200 percent of federal poverty guidelines, Allison said.
Allison also provided a break down, by ethnicity, of the decrease in HealthWave cases between June 2006 and February. The program, which provides subsidized health insurance for children in families earning 200 percent or less of poverty, has almost 19,000 fewer beneficiaries than it did since the adoption of stricter federal enrollment regulations in July 2006. Fearing the program was being abused by illegal immigrants, Congress established new proof-of citizenship requirements for those enrolling or re-enrolling. But critics of the new regulations, including the health policy authority, said the changes had the unintended consequence of screening out thousands of eligible beneficiaries simply because they had trouble dealing with the new paperwork. The health policy authority has been dealing since July 2006 with a backlog of applications numbering in the thousands. The Legislature this past session approved the hiring of additional workers to help deal with that problem.
“We are now on track and beginning to see a decline in the backlog,” Allison said.
According to an agency analysis, the smallest percentage of decrease, 2.6 percent, was among Hispanics. The largest decrease was among blacks, particularly black children, a category that saw a 9.1 percent decrease.
Of the total decrease, “93 percent was non-Hispanic,” Allison said. “This is a counter-intuitive drop.”
Board member Susan Page, administrator at the hospital in Pratt, said there was evidence that those kept out of HealthWave by the new requirements were showing up at hospital emergency rooms.
“Our ER visits are up about 8 percent,” she said.
Allison also provided a report showing the number of health care providers or primary care physicians in each county available to those enrolled in the HealthWave program, which operates under contract to two managed care companies, Children”s Mercy Family Health Partners and Unicare Health Plan of Kansas. Among other things the report showed that seven northwest counties have only one provider each. According to the report, there are 3,299 providers available through one company or the other and that 567 providers work with both companies.
In other action, the board:
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Approved renewal of the annual employment contract for Executive Director Marcia Nielson effective July 1. She will be paid a $127,500 salary and an $860 bonus in December.
“She has carried out her duties in an exceptional manner,” said board member Arneatha Martin of Wichita.
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Was introduced to Roxie Namey, the agency”s new program integrity manager. Namey will be included in the executive staff and will oversee the agency”s interactions with the Kansas Department of Social and Rehabilitation Services, Nielson said. Also introduced was Michael Goldberg, recently hired chief executive officer for Kansas Health Solutions, a managed-care contractor hired by the state to oversee and coordinate community mental health services.
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Heard that the agency will seek another grant as part of the state”s Health Information Exchange initiative to help identify the statutory barriers to the digitizing of medical information and also that the agency will seek a grant from the Robert Wood Johnson Foundation to send members of the Health for All Kansans Steering Committee to “an intensive” three-day seminar in Washington D.C. for a foundation-sponsored seminar on health-care reform.
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Was told that Barbara Langner has been hired as the agency”s new director of public policy. Langner, currently an associate professor at the University of Kansas School of Nursing, said she would begin her new duties in mid-August. Langner also made a presentation describing the demographics of the estimated 300,000 Kansans who lack health insurance. “Most of the uninsured children are in income groups eligible for our current programs,” Langner said.
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Heard that seven applications have been received for the new position of inspector general within the agency. Additional applications will be accepted until Friday, said Scott Brunner, the health policy authority”s financial officer.
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Heard an update on the agency”s work toward developing a health insurance premium assistance program signed into law earlier this year. The program would begin in 2009 and incrementally over four years offer coverage to Kansans earning 100 percent of less of federal poverty guidelines.
-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.