It was once the mark of a good place that government took care of the poor and sick, the elderly, the infirm. But in Kansas, state government has come to savage the poor for having no money, deride the sick for being unhealthy, chastise the elderly for being in the way. Programs to help the unfortunate, such as Medicaid, have turned tragic with all the markings of cruelty, indifference, greed.
Medicaid is the government-subsidized health care plan for the poor who are elderly, the disabled, and for children and pregnant women. Gov. Sam Brownback privatized Medicaid in 2013 under a plan called KanCare. It is administered by three managed care organizations: Amerigroup Kansas, Sunflower Health Plan, and United Healthcare, companies that have donated heavily to Brownback’s election campaigns.
Privatized Medicaid in Kansas is a disaster. Dozens of nursing homes, hospitals, clinics and other providers are choking on unpaid bills. Some have been forced to close. The system suffers a nightmare backlog of applications from thousands of people desperate for help that may never come.
The backlog was to be resolved last June with a new program, the Kansas Eligibility Enforcement System (KEES), but the system had glitches. Applications that once took ten days to process now take three months or more. The number of unprocessed applications is at 10,000 and counting. Some Kansans who had been on Medicaid for years were suddenly dropped with little or no warning, according reports by the Kansas Health Institute news service.
Nursing homes were especially hard hit. The state Department of Health and Environment took over all Medicaid processing, but delays have continued at such a rate that the governor’s supplemental budget for fiscal 2017 (beginning in July) assumes an additional $3 million in Medicaid “savings” as enrollment eligibility continues to lag. Thus, unpaid processing bills are called “savings” in the governor’s budget.
THIS NIGHTMARE balloons with the issue of Medicaid expansion.
For two years, the governor and his Republican-dominated legislature have refused to consider expanding Medicaid under the Affordable Care Act, a delay that so far has cost Kansas more than $1 billion – money returned to the federal government and spent in other states for Medicaid expansion, according to the Kansas Hospital Association.
The issue is a Catch-22 straight from Joseph Heller: Since early 2014, when the Affordable Care Act became law, 31 states and the District of Columbia have expanded Medicaid eligibility to all adults earning up to 138 percent of the federal poverty level, according to the Kaiser Family Foundation.
The annual income limits in expansion states are $16,242 for an individual and $33,465 for a family of four. A Kansas Catch is that a) only adults with dependent children are eligible for KanCare; and b) only then if their incomes are 28 percent below the poverty level, or $9,216 for a family of four. That’s how people are kept off the welfare rolls – they’re starved out.
Hospital officials say Medicaid expansion would provide coverage for about 150,000 Kansans, many currently uninsured.
Another Catch: Conservatives in congress last year demanded budget cuts in Medicare reimbursements through the Affordable Care Act – then complained that the Act was short-changing citizens.
Medicaid expansion would provide dollars for hospitals, clinics and other providers hit hard by the cuts – but solving the problem would eliminate a popular avenue of complaint for conservatives. Thus, they oppose expansion.
The Kansas Hospital Association has proposed A Bridge to a Healthy Kansas, a plan modeled after an expansion drafted by conservative Republican Gov. Mike Pence in Indiana. This plan requires beneficiaries to pay a portion of their premiums while the federal government finances 90 percent of expansion, as required by the ACA. Some Kansas Republicans have expressed interest in the idea, but the party’s state committee recently passed a resolution opposing expansion, declaring such expansions only “offer window dressing to disguise the expansion of Obamacare.”
Another Catch: Opponents decry federal regulations that prevent states from demanding that Medicaid beneficiaries be fully employed. Here, the beneficiaries are elderly, disabled, children or pregnant women – not really an all-star cast for the employment office. But that’s no matter. The Kansas resolution insists that Medicaid expansion fails to promote “personal responsibility and self-reliance” among the poor.
No hearings have been set for Medicaid (KanCare) expansion in Kansas. None are likely. Nor will much be done about the Catch-22 for desperate Kansans waiting for help.