By Mike Shields
KHI News Service
TOPEKA, Oct. 16
Advocates for children and consumers said they were disappointed with the scaled-back health reform plan approved Tuesday by the Kansas Health Policy Authority.
“I”m saddened to see the children”s mandate go away,” said Corrie Edwards, executive director of the Kansas Health Consumer Coalition, referring to a reform scenario endorsed by the board last month that would have required all children under age 19
to have health insurance.
“What”s that state slogan? Big as you think? I”m trying to reconcile that with what they did today,” said Ira Stamm, a reform advocate who favored a plan that would provide universal health insurance.
And Gary Brunk, president of Kansas Action for Children, took the microphone at the end of the board meeting to announce that children”s advocates across the state were disappointed that the final reform plan did not include expanding eligibility for the State Children”s Health Insurance Program to those in families earning up to 250 percent of federal poverty guidelines. That idea also was endorsed by the board last month but rewritten Tuesday.
The very things that disappointed the advocates, heartened legislators who had warned board members after last month”s meeting that the plan would face stiff opposition from lawmakers, if it included mandates or called for large expansions of government-subsidized health insurance.
“It sounds to me like there are a number of aspects of this that are doable. I think we can probably do this in a bipartisan way,” said Sen. Laura Kelly, a Topeka Democrat who was among those who warned board members that mandated insurance coverage for children was politically unfeasible.
Here are the key elements of the reform plan that the board approved Tuesday for formal presentation to the Legislature and governor on Nov. 1. They are contrasted with the elements endorsed b y the board last month before members heard legislators” reactions during a meeting Sept. 26-28 in Chicago:
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Instead of mandated health insurance for all children under age 19 with subsidies provided to those in families earning 250 percent or less of federal poverty guidelines, the board approved a stepped-up effort to enroll children already eligible but not signed up for Medicaid or SCHIP. In Kansas, SCHIP is limited to children in families earning 200 percent or less of federal poverty guidelines, or $34,340 annual income for a family of three. Board members also agreed that if a high percentage of eligible children weren’t enrolled over a certain time period that should trigger
reconsideration of a
mandate that all children be covered. They left it to agency staff to determine the appropriate enrollment percentage for the “trigger” before presenting the reform package to legislators.
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Instead of expanding the state”s premium assistance program to include parents earning up to 150 percent of poverty, or $25,755 for a family of three, the board approved extending the insurance subsidies to childless adults earning up to 100 percent of poverty, or $10,210 annual income for an individual. The Legislature earlier this year approved the premium assistance program which will subsidize insurance for parents earning up to 100 percent of poverty. That program is to be phased in over four years and still requires funding approval.
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The board also approved a voluntary connector or clearinghouse to provide small businesses assistance securing affordable insurance for their employees and to help them develop Section 125 plans, which allow workers and employers to avoid paying taxes on money used for health insurance premiums.
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Leaving details to be developed, the board also approved the concept of a reinsurance program that would have the state and private insurance carriers subsidize the costs of high-risk health insurance policyholders, with the goal of stabilizing premium costs for employers of 10 or fewer workers.
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The board also approved the idea of allowing relatively low-cost health insurance plans for people ages 19-25 that would be cheaper because they provided fewer benefits than found in current policies allowed to be sold in Kansas.
The reform elements approved Tuesday will be bundled with others
approved Monday by the board
aimed at illness prevention. Chief among those were a statewide smoking ban in public places and a 50-cent increase in the state”s 79 cent tobacco tax.
Legislators on Tuesday predicted that both those reforms would be difficult to get past the Legislature.
“I think, in the House, that the majority of members would be reluctant to dictate that much detail in our lives,” House Minority Leader Dennis McKinney, a Greensburg Democrat, said of the smoking ban.
“You know how hard it is to raise any kind of tax in the state of Kansas,” Kelly said of the tobacco tax increase.
“I don”t think it will be an easy sell. I think it will be tough going.”
Sen. Jim Barnett, the Emporia Republican who is chairman of the Joint Health Policy Oversight Committee, said there were ways other than a tobacco tax to pay for the reform plan, which has an estimated annual price tag of $71 million, if fully approved and implemented.
“We in Kansas have a lot of resources,” he said. “But we need to prioritize how we spend. If it”s on prevention, we already have received about $500 million for prevention from the tobacco settlement, but we”ve spent very little of that on prevention. If we don”t have additional resources, we should look at how we”re spending current resources.”
Barnett, who also has served on the health policy authority”s health reform steering committee, commended the board for its work crafting the plan.
“I think that the health policy authority has done their job and put a great deal of thought into this and heard from a great number of stakeholders across the state. Bringing policy to the Legislature, that”s exactly what we asked of the health policy authority. Now we need to look at the details. The devil will be in the details.”
-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.