By Mike Shields
KHI News Service
TOPEKA, Aug. 21
Making health insurance mandatory for Kansas children up to age 19 and paying for those who need subsidies with increased tobacco taxes is one of the reform options being considered by the Kansas Health Policy Authority board.
The agency has been tasked with developing health care reform plans for consideration by the 2008 Legislature, a process it began at the end of the 2007 session and which it aims to complete by Nov. 1. Monday, board members heard reform recommendations from spokesmen from three of its advisory councils. Tuesday, they spent several hours in discussion with consultant Steve Schramm, whose firm will prepare economic analyses of several reform scenarios agreed to Tuesday by board members for consideration at their Sept. 25 meeting.
The board members asked Schramm to flesh out each of the following reform scenarios, which they also titled:
Baseline Scenario:
Premium assistance, a program approved by the 2007 Legislature but not yet fully funded. It would use government dollars to help buy private insurance for parents earning between 37 percent and 100 percent of federal poverty guidelines. Currently in Kansas only adults earning less than 37 percent of federal poverty level can qualify for Medicaid.
Reference Scenario:
Health insurance would be provided to children and adults in families earning up to 250 percent of federal poverty guidelines through expansion of current public health insurance programs.
Sequential Scenario:
This was the one that member Joe Tilghman and board chairman Connie Hubbell said they thought was the most practical and politically feasible. It would operate in three phases, hence the name sequential.
Phase 1: Health insurance would be mandated for all children up to age 19, in essence expanding eligibility for the state”s current
HealthWave
program. Every child who doesn”t already have health insurance would be automatically enrolled. Tilghman proposed that it be financed by a 30 cent per pack increase in the tobacco tax.
Phase 2: The premium assistance program would be expanded to cover adults earning up to 150 percent of federal poverty guidelines. The currently approved premium assistance program would cover all adults earning up to 100 percent of federal poverty by its fourth year of operation.
Phase 3: Premium assistance would be expanded to parents earning between 150 percent and 250 percent of federal poverty. Coverage also would be provided for young adults and the state would implement a reinsurance plan to help curb health premium costs.
Affordable Scenario:
A health insurance connector with voluntary participation. Board members agreed to have this option studied because they were ordered to by
Senate Bill 11
, but they agreed that voluntary health connectors have been proved largely ineffective.
“Based on this discussion…we”re not considering it as an option we”re serious about. But we have an obligation per Senate Bill 11 to bring back a voluntary connector model to the Legislature on Nov. 1,” Nielsen said.
A connector or exchange can operate in different ways but is generally defined as an independent public authority or clearinghouse that helps individuals or employers purchase private health insurance. The Commonwealth Connector in Massachusetts is the best known example, but it is not voluntary. There, employers and individuals are required to participate.
Universal Scenario:
A connector with a mandate that all individuals and employers participate.
The Mountain Scenario:
In essence, the state would become the health insurer for all Kansans, perhaps issuing every legal resident an electronic medical card to be used at the medical provider of the cardholder”s choice. The medical provider would then bill the health policy authority directly for services provided.
Board member Ned Holland, a human resources executive with Embarq, one of the state”s largest employers, said the option would expand coverage to all while cutting costs, essentially replicating the self-insurance programs his and other large companies use.
“If Sprint can do it, Kansas can do it,” Holland said.
But other board members said his proposal was politically “dead on arrival” because, among other things, it would eliminate the need for insurance companies, inviting their certain opposition, and would require significant changes in federal regulations.
“I don”t like incremental change. I like dramatic change,” Holland said. “If we stay with the current system, guys like yours truly are going to continue to squeeze employees, squeeze providers and look to send jobs to India. I think we do the state a disservice if don”tat least describe that big-time, big-bang option.”
“We shouldn”t be that frightened in this country to move away from a system that doesn”t work,” said board member Vernon Mills, a Leavenworth pediatrician, saying he also liked Holland”s scenario.
Board members called it the “mountain” scenario, agreeing it was politically unfeasible but of lofty ambition.
Board members also agreed to spend time at their September meeting discussing in more detail the agreement they”ve already forged to include prevention and wellness programs as components of any or all options they present to lawmakers. They also are expected to hear from the secretaries of the aging and welfare departments about possible reform options dealing with the elderly and others requiring long-term care.
Tilghman, also chairman of the
Health for All Kansans Steering Committee
, seemed to have the backing of fellow members when he said:
“Our elected officials, I think, are a little bit overwhelmed by the sheer magnitude of health reform. They”re clearly nervous about anything involving mandates or new taxes. I didn”t detect much enthusiasm (among them) for doing too much, too quickly. I think we should present a plan to get us there (universal coverage) in incremental steps.”
“We have to move along at a pace Kansas is ready for,” said Marcia Nielsen, the agency”s executive director. “Today we”re talking about those incremental reforms.”
Schramm said his firm has worked with other states on health reform, including Massachusetts, Maine and Connecticut.
He said he”d been told that Kansas wanted advice based on what has been shown to work elsewhere.
“We want practicallessons-learned sorts of things,” he said, describing the marching orders he had been given by the health policy authority.
-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.