By Mike Shields
KHI News Service
TOPEKA, Jan.
8
The 2006 governor”s race is run and done, but the major health issue of that campaign is drawing new breath for the 2007 Legislature, which convenes Monday.
Republican and Democratic leaders agree too many Kansans
about 300,000
lack health insurance. But how to fix that problem remains an unsettled question.
Last year, Gov. Kathleen Sebelius, a Democrat, could not sell the Republican-controlled Legislature on her plan to insure all Kansas children from birth to age 5, which she said could be done for an additional $3.5 million a year. The plan is a priority again this year for the governor and for the
Kansas Health Policy Authority
,
which estimates it will now take an additional $4 million to $6 million to expand coverage to 2,000 more children.
Sen. Jim Barnett, an Emporia physician, was the unsuccessful GOP standard bearer in the governor”s race. He failed to persuade voters last November that a health “connector” loosely modeled on the
Massachusetts plan
was the best way for bringing insurance to more Kansans.
The “Kansas Health Connector” he described during the campaign would be a central clearinghouse through which health insurance policies would be sold, replacing the employer group plans now commonly used. The presumed benefits of the connector would be cheaper premiums resulting from lower administrative costs, better access for employees of small businesses and “portability,” the ability to keep insurance regardless of employer or job change.
Barnett”s plan differed significantly from the Massachusetts model, which many policymakers nationwide are watching, in that it did not mandate employees or employers participate.
In the 2007 session, he said he wants to look at what other states have done and pick what might work best for Kansas.
“I think Massachusetts, like other states going all the way back to Hawaii in the 70s, should be studied and
realizing that none of these plans have solved the problem
see what applies for Kansas,”
Barnett said.
In so many words, Sebelius has compared Barnett”s narrower connector plan to rearranging deck chairs on the Titanic:
“It”s not a matter of difficulty in finding a plan
as a health-connector would indicate
but rather one of affordability,” said Sebelius” spokesperson Nicole Corcoran. “Health care is too expensive. The governor wants to lower the cost of health care, not simply make a variety of expensive plans easier to find on the Internet.”
But Senate President Steve Morris, R-Hugoton, said a brief, private conversation he had with Sebelius on health-care issues left him thinking she would not oppose a “connector” plan, if she were convinced it would help ease the problem of the uninsured in Kansas.
“My impression is that she may be thinking about portions of the Massachusetts plan that would make sense for Kansas,” Morris said. “We talked in general terms about how important it is for us to make some progress on health care.”
And Barnett has said he favors looking at ways this session to get more people enrolled in HealthWave, the current state insurance program for mothers and children from low-and moderate-income households. Both the governor”s and Barnett”s plans will get fresh airings during this year”s session, which means fresh opportunity to seek common ground.
Barnett, who will continue to chair the Senate”s Health and Human Services Committee, said he plans hearings soon after the session on various health topics and in the process explore various options for creating a Kansas connector or otherwise extending health insurance to more people.
His interest in the connector approach is shared by Republicans in the Kansas House.
“There”s quite a bit of interest in the caucus in Dr. Barnett”s plan,” said House Speaker Melvin Neufeld.
Neufeld said he remains opposed to the governor”s plan to provide health insurance to all children ages 5 and under. The governor has pledged to
re-introduce that plan
or something similar as part of her budget proposal to be delivered to the Legislature on Jan. 10.
“The dividing line comes down to (some people”s) core belief that it”s government”s responsibility too see that everyone has health insurance,” Neufeld said, versus “the majority”s belief that health care is a personal responsibility. If we fail to personalize responsibility for health care we”ll be in a downward spiral we”ll never recover from.”
Neufeld said he and other Republicans worry about the growing costs of state participation in Medicaid and will resist plans that increase the state”s exposure.
But the Kansas Health Policy Authority has endorsed the governor”s plan and is including it among its own
legislative priorities
this year. Neufeld said he considers himself a “major creator” of the health policy authority,
which among its other responsibilities is the state”s Medicaid administrator, and that he is pleased so far with its operations. It remains to be seen if that panel”s blessing will carry weight with the speaker or other conservative Republicans. Early comments suggested it would not.
Nor are Barnett and Sebelius the only ones with plans for increasing insurance coverage.
Rep. Paul Davis, D-Lawrence, is the policy chairman for the House Democratic Caucus. He said he would like fellow legislators to consider reviving an earlier failed measure creating a pilot program in Kansas allowing a few, small private employers to join the state employee health insurance pool. Davis took pains to explain that the following idea was his alone and that he was not speaking for the House Democratic Caucus.
And he has another idea:
“Right now, the state employee plan is self-insured, administered by Blue Cross,” he said. “Why not look at essentially privatizing that plankeeping it there as a purchasing pool and then buy from companies that could make bids and offer the consumer a menu of options from different companies. That is an approach that is very much in line with a capitalist, market economy. The government”s role is to offer purchasing power.”
There appears to be greater consensus this session on some other health issues.
Expanded newborn screening
Kansas Department of Health and Environment is pushing to increase from four to 29 the number of diseases for which newborns are screened. Kansas is one of only eight states that currently screen for fewer than 10 conditions. The American College of Medical Genetics recommends screening for a minimum of 29 conditions. Leaders from both parties in the House and Senate said they also favor expanding the tests, which would help identify various rare but potentially life-threatening diseases or genetic disorders.
Tobacco
Despite urging from some health advocates, no one in top House or Senate leadership or the governor”s office is pushing for increased tobacco taxes. The Legislature rejected a 2004 plan by Sebelius to increase the cigarette tax to pay for extending health insurance to thousands of uninsured Kansans.
And no one in leadership seems to think a tax increase is in the making for this year.
“I don”t think it”s a starter,” House Speaker Neufeld said, meaning the idea is probably going nowhere.
“As you know, the governor put forth a plan to increase the cigarette tax in the past to help add coverage for more Kansans in need but that was not well-received by the Legislature. I haven”t heard discussion of pursuing that again at this time,” Corcoran said on behalf of Sebelius.
“I haven’t really picked up an interest from very many legislators…some may be interested but I don’t know if there are enough for viable push to get an increase,” Senate President Morris said.
Leaders also expressed little interest in a statewide smoking ban.
Neufeld said he agrees any increased money the state receives from the Master Settlement Agreement (MSA) with major tobacco companies should be spent on prevention or programs that help people stop smoking.
He also said he was interested in “equalizing” the amount major tobacco companies pay into the settlement. He cited Liggett as a company that is increasing market share while not paying into the settlement pool.
“Right now, the growing market share is with companies not paying into the MSA,” Neufeld said.
Childhood obesity
Legislative leaders and others said they want to look at programs to mitigate the problem. Neufeld said he thinks the House will, as a first step, approve a statewide measurement of student BMIs (
body mass index
) “but without personal identifiers like
Arkansas
did. That upset a lot of parents.”
But he and other leaders stopped short of endorsing mandatory physical education for all grades, which some health advocates have proposed.
“A number of schools have pretty good PE programs. We should see which schools are getting good results,” Neufeld said. “We need to know the good things that work before going to mandatory measures.”
“Gov. Sebelius encourages kids to be active and urges schools not to cut physical education, however healthy habits begin at home,” was the reply from the governor”s office when asked if she would support mandatory physical education.
Marcia Nielsen, executive director of the Kansas Health Policy Authority, said her agency will ask legislators to approve about $1.5 million for childhood obesity counseling, including incentives to monitor BMI, diet and physical activity.
Davis said House Democrats “want to get junk food out of the schools and I think we”re going to see further efforts to try to do something about that.”
There also are several health-related issues likely to emerge or resurface that still lack consensus. Among them:
Inspector General
Last year, the Senate approved 40-0, funding for a new inspector general position in the Attorney General”s Office charged with turning up fraud and inefficiency in the state Medicaid program. The House stalled the measure, which was then sent to the Legislative Budget Committee for interim study. Senate Majority Leader Derek Schmidt, R-Independence, continues to push the bill.
It also has the backing of Senate President Morris, who said reining in state
Medicaid
spending “is a big priority for me” this session and that he sees the inspector general bill as part of that effort.
“There”s different guesses on the amount of possible fraudulent use of Medicaid,” Morris said. “I don”t think we have a large percentage but even a small percentage takes up a lot of dollars, so I think it is in our best interest to pursue anything that can prevent misuse in the Medicaid program.”
Schmidt told the interim committee that by conservative estimate there is a 5 percent error rate in Kansas Medicaid spending, which means $44 million a year is misspent.
During the interim, Schmidt also convened an “informal discussion group” to work on the inspector general issue. The group included representatives of the Attorney General”s Office, Kansas Medical Society, Kansas Hospital Association, EDS, and the Kansas Health Policy Authority, which now oversees the state”s Medicaid program.
Nielsen, executive director of the health policy authority, said her office favors creating an inspector general but “the proposed bill creating a single agency Kansas Inspector General does raise some questions and concerns in concept and execution.”
She said her agency has provided Schmidt “recommendations for legislation that would maximize program integrity of Medicaid.”
KU Medical Center affiliations
The medical center, home to the KU School of Medicine, is considering various affiliations with the major Kansas City metro hospitals, including those in Missouri, as part of a broader push to make that city a national leader in bioscience research.
On Nov. 14, 2006, the University of Kansas Hospital, which is in Kansas City, Kan., made an almost $400 million affiliation offer to the medical school and center. But KU Medical Center leaders say the offer would limit the center”s ability to affiliate with other Kansas City hospitals and thereby hinder future fund raising needed to meet the goals of a broader Kansas City blueprint for higher education and bioscience development titled
“Time To Get It Right: A Strategy for Higher Education in Kansas City.”
Details of the University of Kansas Hospital offer, which would spread the money over 10 years, weren”t made public until Barbara Atkinson, the medical school”s dean, wrote a
Nov. 27 letter to KU Medical Center staff outlining the proposal.
Subsequent press accounts and editorial columns brought broader attention to the affiliation negotiations and raised questions among some legislators.
Last month, spokesmen for the medical center and the university hospital appeared before the interim Legislative Budget Committee and pledged the two institutions would work together to develop an affiliation agreement that would benefit their organizations, the state and the Kansas City bioscience initiative.
The Kansas Board of Regents and some legislators have said they don”t intend to “micromanage” the negotiations. But others say the Legislature is obliged to watch carefully.
“I believe the state has a major responsibility in overseeing the process,” Sen. Barnett said. “This relates to health-care manpower. A significant number of our primary care providers are trained at KU. We have a responsibility to the state of Kansas to protect and retain those training centers and training focus in our state.
“I”m also concerned about the influence of promises and large amounts of money directing policy for the people of Kansas. Through my six years in the Legislature, I understand too well the influence of money on politics that doesn”t necessarily translate to the best public policy for the people of Kansas.”
Speaker Neufeld said he was surprised by the sum that University of Kansas Hospital offered the medical center.
“What the hospital offered is a whale of a deal that (the medical center) should pick up on,” Neufeld said. “The hospital proposal includes significant research dollars.”
But Neufeld also said he thought it was the duty of legislators to keep tabs on the proposed affiliations.
“After all, they are the Kansas University Medical Center and hospital,” he said. “They are functions of the state, they should not be decoupled from state policies. I don”t think the state of Kansas has any obligation to bail out out-of-state hospitals.
“The medical center and the hospital need to sit down and work it out. I also told the Hospital Authority we”ve failed to have proper legislative oversight. Sending a letter once a year saying what you”ve done is probably not enough.”
The University of Kansas Hospital is the bigger of the two operations once equally bound to the university and the state before the Legislature in 1998 created an independent authority to oversee the hospital. The Legislature”s involvement with the hospital authority has been minimal since then.
Kansas Health Policy Authority
The recently created agency that is now in charge of the state”s Medicaid program and the state employee health plan has as its
top priority
gaining legislative approval for 60 more employees.
Most of the agency”s current employees were drawn from the ranks of other agencies such as Social and Rehabilitation Services and the Department of Administration. But some lawmakers aren”t convinced the other agencies surrendered as many employees as they should have when the health policy authority was born.
“It”s pretty clear to everyone in this building (the Statehouse) that every agency that was involved tried to keep from giving up people,” said Speaker Neufeld. “Nobody transferred any budget positions. With Medicaid, does that make sense? Yeah. We have to add FTEs (full-time equivalency positions). The question is do we transfer them from other agencies?”
Specialty Hospitals
There has been concern among some general hospital administrators and state policymakers that so-called
specialty hospitals
are doing competitive harm to the state”s general hospitals, particularly in rural areas.
The specialty hospitals treat a much lower proportion of Medicaid and uninsured patients than general hospitals. And
they specialize in a few procedures such as hip replacement. Typically, they include their doctors among their owners. The health policy authority is expected to report to the Legislature in March its recommendations for dealing with this fast-growing segment of the health-care industry and early discussion among board members suggested some interested in greater regulation.
“Probably all the damage has already been done to the rural hospitals,” said Neufeld, who is from the small town of Ingalls in western Kansas. “So, the big question is what”s going to happen in Johnson and the other urban counties.”
Noting the recent purchase of a specialty surgery center by the general hospital in Dodge City, he predicted threatened general hospitals would likely buy out the competition.
“On the positive side, I think (specialty hospitals) drive better quality care at the general hospitalsthat competition factor is actually helping our hospitals. Everything has an up- and down-side. Of course, the real issue is the Kansas definition of a hospital and that”s the tough issue.”
The legal definition determines whether a
hospital or specialty center
is eligible for Medicare reimbursement. The definition issue “will be discussed because there will be a lot of varied pressures to do that,” Neufeld said.
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.