Delaying hair for these people is life altering.
For the first time in four years,
Kansas lawmakers had a hearing on Medicaid expansion.
It's an issue that sparked A heated debate at the
State House.
We're taking a look inside Kansas politics.
Welcome in. I'm Rebecca Chun.
Opponents of Medicaid expansion are questioning the cost and its
effectiveness,
but supporters are calling on lawmakers to fill gaps in
coverage.
I was there for the hearing on Wednesday,
and here's a look at what both sides are saying
Blues filled, wall to wall with people from across Kansas
all coming out to talk about Medicaid expansion.
Delaying care for these people
is life altering. The House Health Committee talked about the
governor's bill.
It would expand Medicaid to
150,000 Kansans that fall in the coverage gap.
I can't quit my job,
I can't go to the doctor and I can't get
Medicaid.
That's that gap triangle that we find ourselves ourselves in
too often when we're working with our consumers.
The bill would also include work requirements,
Democrats attempting to address concerns from some Republicans about people
taking advantage of the system.
It's a non disabled, non elderly adult of a certain
age.
That's
by federal law. That's That person
in other welfare programs is called again in law,
unable bodied adults. During hearings,
supporters laid out a long list of arguments,
and one of the main ones include helping the state
tackle its rural hospital crisis.
I saw the grim reality of uncompensated emergency care for
uninsured Kansans drive up the cost of health care for
insured Kansans.
Benjamin Anderson says he didn't support Medicaid expansion until working
at a rural hospital himself.
Each year, hospital had to scrape together the money to
stay open,
and around that time, we started seeing the financially stressed
rural Kansas hospitals closed their doors.
This dynamic still exists today.
The governor has been pointing to data from a national
Policy Institute sounding the alarm on rural hospital closures in
Kansas.
As of last year, 58%
of Kansas's rural hospitals were at risk of closing,
and nearly 83% lost money on patient care.
But some opponents are concerned about the cost,
worrying that the state will be on the hook for
money from the feds.
The costs will turn out to be higher than even
the highest official projection during the debate.
As for whether the House bill will move forward,
that will be up to the Republican chair of the
committee.
We asked her whether she plans on working the bill
and moving it to the House floor.
How likely are you to work this bill and send
it to the House floor?
Well, the committee will decide whether it goes to the
House floor or not.
So we're looking at possibly working in.
All right. Today we're talking with all sides on the
issue.
Joining our panel is Speaker of the Kansas House Dan
Hawkins,
Executive Director of Alliance for Healthy Kansas,
April Holman and political analyst Bob Beatty.
All right, we can start now.
That bill that we were mentioning in that
a story it failed to pass out of the House
committee just one day after the hearing.
And at that hearing there were hundreds of supporters of
Medicaid expansion that wrote In still speaking with the chair
after the meeting,
she did indicate that her stance remains the same.
She opposes Medicaid expansion and one of the points opponents
brought up during the hearing was that mainly able bodied
adults would be receiving coverage.
So let's talk about it.
Speaker Hawkins, let's start with you that that is correct.
The, the actual, the actual way it reads is age
19 to 64 able bodied adults
are that is the population that is Medicaid expansion.
A lot of times when I go out and talk
with people,
you'll hear people say Medicaid.
I'll ask them what's what is Medicaid expansion and they'll
say it's helping out the frail and elderly or the
OR the disabled, whatever they say.
But well, almost none of them really know that the
true population for Medicaid expansion is
1964 able bodied adults, people who can go to work.
And if they go to work
and they work enough to reach the federal poverty level,
which is about
14,580,
almost 15,000, then they can get on the ACA and
have almost virtually
all of their premiums paid for
cost them 20 or 30 bucks a month.
Plus
95% of their out of pocket cost is paid for.
OK, Director Holman, is that the stands from your organization?
What's your take? Well, I think that when we talk
about able bodied adults,
really I've just found out that's a term of art.
And So what we think of as people who are
able bodied or who don't have
a physical reason or a behavioral health reason for not
being able to work,
that is not the definition that we're using here.
So when what we see is there are a lot
of people who actually do have what we would consider
disability in everyday language, people who might have a chronic
illness like heart disease or diabetes or people who might
have cancer,
they don't qualify for the disability determination from the Social
Security Department
administration, but they absolutely have what we would think of
as a disability.
So I think it's a misnomer to
think about everyone who's in the coverage gap as being
able to go out and work.
In some cases, people are limited in the amount of
hours that they might be able to work.
And when you look at the income thresholds,
we talk about the coverage gap as being those people
particularly who earn less than 100%
of the federal poverty level.
So that individual that Representative Hawkins talked about might be
able,
if they have a household of 1,
to qualify to be able to get those subsidies on
the marketplace if they are earning
$15,000. But there's a penalty if you have more people
in your household.
So if you have a child or if you have
two children or even more,
it becomes more difficult for you to meet that threshold
and be able to get the subsidies
on the marketplace. So we're talking about people who are
really without options to get assistance so that they can
get affordable healthcare.
OK And Speaker Hawkins wanted to get back to you
there.
What did you think about what April Director Holman was
saying?
Well, Able Body Adult is actually,
it's a it's a federal term.
That's that's what they call it.
I didn't, we didn't make it up.
And they can work. And if they can work,
they're going to be able to get on.
They have options. They do have options.
You know, I, I, I find it interesting today when
we literally have
thousands of jobs available that we have people that don't
want to go to work.
About 40 percent, 30% of those that are in this
population actually have coverage.
They already have coverage. They will be forced off of
coverage and on to Medicaid.
So that's that's that's a cost that actually hurts the
hospitals
because they're getting a higher reimbursement rate from insurance than
they will from Medicaid.
And and for us, you know we're trying to also
help out Medicaid.
We've we're working on right now
increasing the Medicaid reimbursement rates
that our hospitals and doctors receive,
which we believe that's going to help the system out
a lot.
OK. We're going to get into that a little bit
more later.
But before we go there,
Speaking of work, right the bill being proposed by the
Governor,
it does include work requirements,
but with some exemptions. Some of those exemptions include full
time students and post secondary educational institutions or technical colleges,
parents or guardians of dependent children under 18 or incapacitated
adults,
Individuals unfit for employment or experiencing hardship as determined by
the KDHE Secretary or with pending applications for Supplemental Security
Income or Social Security Disability Insurance.
Individuals with permanent partial disabilities and then also volunteers working
at least 20 hours per week at nonprofit organizations,
homeless individuals, veterans, former foster youth,
underage 22. It's a long list.
However, there's still a bill in the Senate,
so if the Senate takes it up,
we could see some movement there.
Do these work requirements, though,
effectively address concerns about Medicaid expansion?
Not serving the most vulnerable?
And Speaker Hawkins, what are your thoughts on that?
No they don't in in in an actuality
there has the the the Obama not Obama
Biden administration has not allowed a single work requirement to
go through.
So I think there's been 13 of them proposed and
every one of them has been declined.
This one is really interesting because all you really have
to do to get to to to
qualify through this work requirement is to once a year
show that you have gotten a paycheck.
Doesn't. It doesn't have any definition of how much you
have to work it just once a year.
You have to prove that you have worked sometime during
that year.
If that's not really a work requirement
as in in, quite frankly the administration is not going
to allow that to go through.
So it's really, it's really easy for the governor to
propose that because she knows it's not going to go
through as well.
Director Holman, what's your take?
Do these work requirements work,
do you think?
Well, I first of all want to say that the
Alliance for Healthy Kansas does not support work requirements,
and one of the reasons is because the majority of
people who are in the Medicaid expansion population are already
working.
We know that 69% of the people in this population
are working at least one job,
if not multiple jobs. And of the remaining
31% who are not working,
so many of them are people who have a child
under the age of 18 at home and are caregivers
to that child,
caregivers to family members who have a disability or are
seniors.
There are a lot of people who have a disability
themselves who are in that population and are not well
enough to work.
We see that in particular
in that population between say age 60 and 65 where
people are getting close to being eligible for Medicare
and they're starting to see things breakdown in their bodies
and more illnesses happen.
So you know, I think from our perspective because such
a large majority of people are already working,
the work reporting requirements just end up being another hoop
for people to jump through and we don't want to
see any
additional barriers being there that would prohibit people from getting
access to the Affordable Care they need,
OK. And So what your argument is they are working,
they just don't meet that coverage requirement.
And Speaker Hawkins, you're saying that I think,
I think one of the interesting facts that came out
during the
hearing that we had
and this came from KHI,
4040% of this population is between 19 and
2540%. So there is really a young population
and you don't see all the disability in the young.
So I think there's, you know,
I think I think a lot of times you can
make
things seem worse than what they are.
But these people, 1925 can go to work and that's
40%
of the population, 30% of the population
already have coverage. So we're going to take them off
of coverage.
So you're talking now 70%.
There's 30% left. OK,
April, could I just clarify?
So in the cage I report,
they are saying that
69% of the people are working.
So that gets back to that,
that young population that we're talking about.
That data does not show that they're not working.
It just shows that they're probably working in low wage
jobs and struggling,
which kind of makes sense when you think about people
starting out in their careers.
And so I just wanted to kind of make that
clarification that we're not saying that all of the people
have a disability who are in the Medicaid expansion population.
There are a variety of reasons that people don't have
access to
health insurance through their employer or they're not able to
afford the employee contribution.
So that's really who we're talking about,
who are in this coverage gap as opposed to people
only having like one thing,
like everyone doesn't have a disability,
everyone doesn't have,
you know, employer sponsored insurance that they can't afford.
It addresses a lot of shortfalls that occur throughout the
state on a regular basis.
Bob, what are your thoughts on this debate?
Well, it's, it's interesting. It's really how individuals,
states, groups, countries look at healthcare
and every industrialized country in the world has national healthcare
except the United States.
That's fine. It's the US choice to do that.
Bill Clinton tried it in the 90s and it didn't
go through.
Barack Obama with Obamacare, put in almost a piece meal
system knowing that he couldn't get a national healthcare system
through.
And interestingly enough when it was written
they they really did not think any state would refuse
Medicaid expansion.
It's it's kind of naive I guess they honestly thought
no state will refuse this because it's such a good
deal in terms of
the money that comes from the feds.
But again, this is America and a number of states
said no, we'd rather not do this.
Our our political culture is is such that it is,
but it's been a number of years now and slowly
but surely more and more states have have decided to
do it,
including some recalcitrant states in which they went to the
initiative petition and actually just the people voted for it.
So it's really how how a state or a group
of people within a state and their political culture look
at healthcare.
Is it something that's sort of a luxury and I've
got it and you don't you need to work for
it or is it something that you know almost like
a public good, this it benefits the entire state,
everybody from A-Z if we're all healthy.
And that's that's really the debates that have gone on
in states.
And I think this is indicative of that.
And really the people of Kansas have to decide how
they view healthcare.
I think before you know
something's going to happen. Bob,
you also mentioned money. We're going to get into that
right after the break.
We'll be right back. You're watching Inside Kansas politics.
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Welcome back to Inside Kansas Politics.
I'm Rebecca Chung. We're continuing our conversation on Medicaid expansion.
Now the next topic is the cost.
There's been incentives to expand with the promise of a
90%
match rate from the feds.
But opponents are skeptical because they're wondering how much would
this really cost?
Now, Bob, how much would expansion cost based on your
findings?
That's a trick question and I'm joking because there's been
multiple studies
and one of the studies that I read recently said,
well, it depends on the state and there's so many
factors that go into it.
But a couple important points.
One is the, I think it's first couple years,
it's a, it's the Fed,
it's all federal money. And there's recently been an incentive,
you know, from the Biden administration cutting 5%,
adding 5% of more federal money
to get states that have not joined to do it.
So the first few years are,
as you know, essentially free,
not actually better than free because it's all paid for
and that money is flowing to the state.
But then yes, states have to start paying for it.
The studies show some states
complain this is more than we thought it was going
to be.
Others, to my point earlier are,
hey, this is a good deal.
You know, what we're paying is is great.
You know, we're we're happy to pay for it because
what we're getting tends does tend to fall a little
bit along some political lines.
But it's really, again, I know we have,
there's costs associated with it,
but it's really what the people of a particular state
think it's worth.
It's a good deal if if that's what you want
because instead of the state having to pay all the
costs to help these,
to get, to help these people get insurance,
they're getting a big
hand from the federal government.
And so they see it as a good deal,
even if it costs more.
So but we're talking maybe
200 million to 350 million /
10 years are some of the estimates I've seen.
All right, how much is it worth Speaker Hawkins,
what is the hold up do you think on this?
So so I've been in this arena clear back to
the start and in the start the the
KDHE had a study done.
It was done by Aeon
and Aeon's a huge company and they did the actuarial
study,
I actually. If I would have had my personal computer
here today I would have had those numbers exactly and
I'd brought them with me but I didn't have didn't
have my personal computer here so
but I kind of I kind of know close.
So that study in KHI,
really their numbers mirrored pretty close to what the AEON
study was but
65,000,000 is the cost generally.
I mean you can, you can use other
funds to lower that, but
65,000,000 is about the the amount,
it's a 9010 match. So it's going to be around
707 million that the that the
feds, feds have to put in into into it to
kind of start out And that's going to grow over
time because quite frankly our caseloads grow over time.
They always do, our caseloads for Medicaid grow about 100
million a year.
So it's a very fast increasing
program. Our program is just,
it just takes a lot of money.
So the cost is there.
Now how do you fund it and how do you
fund it for the long term
And in some states right now are truly suffering.
Indiana's the latest, Indiana's a billion dollars in the hole
right now this year.
When I when I talked to some of my friends
back there,
I said what are you going to do?
And they said we're struggling with that.
And then all of a sudden it came out just
recently in the in the news that they're actually going
to
close that gap by taking away
benefits from the people who have been on Medicaid for
a long time.
They're not taking it away from the expansion population.
They're actually taking it taken away
from the caretakers of the people that take care of
disabled people and and that and that's something that we've
we've talked about a lot and said,
you know there's a cost.
And when the cost gets too great,
they're going to have to cut benefits.
And when the federal government can no longer pay the
cost and that's that day is coming,
that 9010 match will end and it'll go to a
6040 match and that will truly put states in a
in a death spiral when it comes to the fiscal
nature of Medicaid expansion.
Director Holman, before we move on,
would you like to respond?
Certainly, yes. I I have a couple of responses to
some of the things that
Speaker Hawkins said. So I am familiar with what's happening
in Indiana and
the shortfall that they have in their Medicaid doesn't have
anything to do with the Medicaid expansion population.
It has to do with the HCBS
home and community based services and also the frail and
elderly population.
So the problem that they had there was a
missed estimate of how many people would be served and
how much it would cost.
So this idea that somehow Medicaid expansion is the cause
for that billion dollar deficit
does not reflect what we are hearing from that state
about the
source of their shortfall. I think that I'd also
like to just point out that under the Kansas Health
Institute report that estimated costs,
they found that because Kansas as would any newly expanded
state would receive a signing bonus,
an incentive to if we were to expand our eligibility
for Medicaid,
that would actually result in a positive
net cost to the state of Kansas.
So we would bring in additional money for the 1st
and 2nd year because that signing bonus is just for
the first two years.
But certainly if the state wanted to hold on to
that money for the purpose of paying for expansion,
that would go out almost eight years.
So under the KHI report,
they found that it would cost about
$171,000,000 to of state money over the course of ten
years.
So I think when you look at it that way,
it's a relatively small cost and you're benefiting a large
number of Kansans as well as the providers who take
care of them.
All right, we're going to move on now to rural
hospitals.
So Director Holman, some people
worry about the cost of not expanding,
right? They argue that Medicaid expansion could be a tool
for rural hospitals in Kansas.
They're at risk of closing.
But how much of A tool is really the question?
So if you could respond to that as well?
Absolutely. So at the Alliance,
we've never said that expansion is a silver bullet to
take care of all of the issues that are faced
by rural hospitals.
We know that they're probably going to meet need to
be some changes in the way that Healthcare is delivered
in rural areas.
And we think that you know that process is happening
right now today of finding those innovations and ways to
take care of some of the challenges that are being
faced. But regardless of what new system is rolled out,
there needs to be a payer source for people who
don't have insurance and fall into the coverage gap.
And so in that way,
we see expansion as a way to bolster the financial
stability of rural hospitals and to really give them some
time to be able to be around while this innovation
is happening. Because hospitals, particularly in rural areas,
are the lifeblood of the community.
And they're the key to being able to bring in
new businesses in many cases and to keep the population
there in the community.
So, you know, I, I think that it's very important
to rural hospitals,
not the only answer that needs to happen.
Speaker Hawkins, what's your take?
Well, the alliance may have never said that,
but the governor has said it many times.
I remember when Fort
Fort Scott closed, Fort Scott Hospital immediately came out.
Medicaid expansion would have solved that.
Even the CEO said no.
It would have kept U.S.
Open maybe 2-2 months. Two months,
two months, not two years.
If you have a if you have a company,
let's just leave healthcare alone.
If you have a company that's losing 15,000,000
and they get 2,000,000, how do they stay open?
They're still losing 13 million
in in. That's that's what's happened at virtually every hospital
that is closed in the state of Kansas.
She is right. It's not the silver bullet for
rural healthcare. Matter of fact,
the silver. I wouldn't even say this is a silver
bullet,
but it sure helps. Getting the reimbursement rates for Medicaid
is so important for the rural hospitals getting that up
and and we decided this year that that was one
of the things that we were going to spend a
lot of money on and and and it's close to
I think it's 70 million or 80 million that we
have put into
that effort raising reimbursement rates for doctors 15%
and for hospitals 30%.
And that truly when you look at our reimbursement rates
it's,
it's deplorable. I mean I
quite frankly when you have Medicare paying X
and you have Medicaid paying
-80% that's bad. We had one code,
it was amazing. We had one code that was
$600.00 on Medicare and $48 on Medicaid.
That's just impossible. And so one of the things that
we have to do is to raise the,
the Medicaid reimbursement rates and that's truly going to help
the,
I I believe that actually helps the hospitals more than
Medicaid expansion ever can.
OK, We're going to talk about that more too as
well.
But before that, another question here,
another concern that came up
as the potential for an increase in Medicaid fraud if
we do expand.
So is that a valid concern,
Bob, do you think? Of course it is.
Sure.
Yes, it's probably one of the biggest
challenges for state governments in the next 10 years.
We saw what happened during COVID with with unemployment claims
and and Medicare and that would no doubt.
You know, I guess I would argue that if if
Medicaid expansion
did occur, I would say it certainly should go hand
in hand with a system that can stop fraud because
it's it's been really bad in Kansas along with other
states. So yeah, it's a definite concern.
OK And Speaker Hawkins, what are your thoughts?
We do have a Medicaid Inspector General
and that department is growing
simply because of the amount of fraud that's happening and
Medicaid and and really
if you went to the federal level and looked at
Medicare,
there's a lot of, there's just a lot of fraud
in healthcare
and in rooting it out is sometimes very difficult.
And so we've had, we actually have had a
Inspector General since probably somewhere around 17 or 18.
Sarah Freddick, she was our first Inspector General and Sarah
did a fantastic job.
We do have a different one now and they're really
trying to boost that office.
We really grow it a lot,
but simply because of the amount of fraud that they're
finding.
So
he's right.
We just have a lot of fraud in government.
We see what happened in our,
like you said in COVID during on our unemployment system,
it was just deplorable how much money we lost.
Yeah, most people don't even know the attorney general,
whoever it is, gets a lot of attention to various
things.
But actually one of the main jobs of the attorney
General in Kansas is fraud,
Social Security fraud, Medicare fraud,
and that hundreds of millions of dollars
every single year going after that.
Well, our director, Holman rather,
what is your take on this argument when it comes
to increasing Medicaid
fraud with Medicaid expansion? Well,
I was actually going to say something similar to what
Speaker Hawkins said,
except maybe with a little bit of a different twist.
We have full confidence in the office,
the attorney general's office and the office of the Medicaid
Inspector General.
And so we believe that they will be able to
identify and prosecute
when there are cases of fraud.
That's not a real concern to me because I think
that they'll be able to take care of it.
All right. Thank you all.
When we come back, we're talking about alternatives.
What other options are on the table?
We'll be right back. You're watching Inside Kansas politics.
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Welcome back to Inside Kansas Politics.
I'm Rebecca Chung. Now we're talking about other options that
are on the table for Kansas lawmakers.
And right now, one of the alternatives to Medicaid expansion
that's being discussed is raising medical reimbursement rates.
So how could that impact healthcare costs,
do you think Speaker Hawkins?
Well, it's certainly going to,
it's certainly going to impact
the providers and that's what it's intended to do.
Our, our providers, the reimbursement rates are so low
for Medicaid. It's it's just it's,
it's it's really deplorable where we're at and and it
hasn't been touched in years.
I think
before the doctors received a 3%,
a small 3% raise last year have been 19 years
since they had received an increase in their reimbursement rate.
Hospitals about the same about 20 years
and and and there's truly a huge
chasm between what Medicare would pay and what Medicaid pays
and it's not something that we can
correct overnight because it's very costly.
We're going to spend somewhere around $70 million this year
just doing what we're doing and that's a 30%
increase for the the hospitals and and a
15% increase for the doctors.
So we're going to have to do that over several
year period.
It's not just going to be a one time thing.
We're going to have to continue doing that
and and that's OK, we understand that.
But but for hospitals, raising the reimbursement rate is truly
a necessary thing And I truly think that
as we get to where there's more parity there,
the hospitals will stop feeling quite as much pinch as
what they have.
You know, you know, really when you look at the
whole system,
if you go back to when Obamacare started,
the ACA, I'm sorry, I didn't really
mean to do that, but
I don't really look at the ACA as a political
thing.
I really don't. The ACA is really baked into our
system now and everybody knows what it is.
But, but the ACA took away money from rural healthcare
in the form of Medicare reimbursements went down.
And that really is what's hurt the hospitals is,
is that a lot of their money was coming from
Medicare and and then they thought it was going to
come from Medicaid.
So they lost money and then there was no money
to come in behind it.
So that's the reason why for us it's pretty important
for us to raise the Medicaid reimbursement rates.
Bob, what are your thoughts on this debate?
Because it seems like raising reimbursement rates,
Medicaid expansion, it would help with healthcare access but in
different ways,
right. I still, I still call it Obamacare.
I maybe I'm just getting old now and it's hard
to,
but it's interesting because I I remember
interviewing Governor Brownback and and around that time when
the ACA was was passed and
he I remember him saying well we still have people
on the waiting list.
We got to take care of that first
and that sort of ties into reimbursement rates as well,
which is this idea, hey,
we have to take care of these things.
Problem is, OK, but Kansas did not take care of
those things.
And so it almost became this loopy argument not to
have Medicaid expansion.
Oh, we can't do that because we got these other
things and I always thought,
well, OK, let's do the other things.
And then Kansas didn't do the other thing.
So that's people in the past.
And so these, these, they certainly need to be done.
And and the big question is,
could both be done Medicaid expansion and the others.
Some would argue yes, but there's others that say,
no, we don't want to do those at the same
time.
Well, Director Holman, do you think raising reimbursement rates would
be effective as well?
I think it's they're long overdue.
So I would absolutely agree about that.
I don't think that they're a substitute for Medicaid expansion.
So when you look at expansion,
you're helping over
150,000 consumers gain access to
affordable health coverage and through the through the Medicaid program.
And so we are really talking about apples and oranges
here.
I absolutely think those reimbursement rates should go up and
I think that it will help in many ways,
but it does not provide the same
coverage and service that Medicaid expansion would to those consumers
who are in the coverage gap now and working hard,
but just not making enough to be able to get
those subsidies on the ACA.
So yeah, I think very important,
not a substitute for expansion.
And really when we look at other alternatives to that
have been proposed,
instead of doing expansion, they all come largely at A
at a cost directly to the state.
So state general fund dollars are making up a large
part of that difference.
Whereas with Medicaid expansion we would be able to take
advantage of that enhanced match rate where
90% of the cost is being borne by the federal
government and Kansas specific task taxpayers are only paying for
10%
of the cost. So it really doesn't make sense to
me why we would want to think about alternatives.
Again, not necessarily the rates,
but other types of things that would take care of
part of the issue
that expansion might do, but it costs more and it
doesn't cover the same people and
you know, people all over the state in the same
way.
OK, let's also talk about the disability wait list,
'cause this was a concern raised by some Republicans during
hearings.
And so Representative Will Carpenter,
he said he's worried about expanding care to
150,000 Kansans when there's still thousands of people on the
disability wait list.
Is there a link here?
What expanding impede this? Can we do both?
Speaker Hawkins, what are your thoughts?
Well, First off, I would say I'd push back against
Bob just a little bit on
Brownback's time period. He actually,
he actually did away at one point with the wait
list on physical disability,
did away with it totally for one day
and then it started filling back up and that's the
way a wait list works.
I mean it's really is,
it's really kind of a
it's it's kind of a strange thing.
It is important for us to do away with that
wait list.
It truly is because we have people
and it cost a lot of money.
Why haven't we? I mean,
we've got 6000 people on that wait list right now.
It would cost us hundreds of millions of dollars to
do away with that and quite frankly will Carpenter representative
Carpenter would tell you we do not have the services
out there to be able to absorb those people right
now.
And So what they've done this last few years is
they've really been working at at
at building the reimbursement rates for those companies who handle
those people.
That way they can build up the,
the, the capacity to be able to handle them.
And so they put a lot of money into that.
Now this year actually, we have been on the governor
for quite a while to
appropriate, I mean she could not appropriate but to budget,
she provides the budget. We work from her budget,
but she never would. She would never put money in
there for the wait list.
And so we decided this year to do it ourselves.
And once she found out that we were going to
do it,
she came in with a
governor's budget amendment to kind of jump in front and
then take a little bit of credit.
That's fine. So we just doubled it.
She said
250. We went on ahead and and doubled it to
500 people that we want to get off there,
but also to put a requirement in that
budget bill that there could never be any more than
4800, which is still too many on that wait list.
So even after we take those 500 off,
we're just starting. We still got a long ways to
go to,
to work through that. So that's important for us because
these are people that have been on the wait list
for anywhere from 10 to
1314 years
and they're going to remain on there until we have
the money to get them off.
Well how much money do you think it would cost?
Oh it cost. So when when when Sam Brownback worked
on that one wait list back think he put
$65 million in to get back then was a small
amount 1000 people off of the PD wait list not
the the actually the the physically disabled is much less
complex than the IDD. The IDD is very,
very difficult. They have many many different problems that you
have to be able to deal with and they're so
much more expensive.
So the PD wait list was very easy to do
away with the the
the IDD is very difficult and it just takes a
lot more money.
I would, I would say probably for us to do
away with that whole wait list,
probably probably half a billion.
Yeah, a lot. And Bob,
I'm going to have you weigh in on the debate
soon.
But first, April Director Holman,
I wanted to get your take on this.
Would this impede expanding Medicaid?
What can you do both.
I think you certainly can do both.
It's like comparing
investing in roads to reducing the waiting list.
The part the the Medicaid expansion funding is a completely
separate funding stream from those HCBS waivers
that would that that have the waiting list.
And so really the legislature absolutely has the opportunity to
put more money in
and to deal with the the shortage in caregivers that
might be that might exist and might be impeding the
progress there
and still do Medicaid expansion,
particularly because we're not looking at a cost for Medicaid
expansion in the first couple of years at least,
no matter how you look at it.
So I also know that many of the people who
are attendant caregivers for people who have a disability and
may be on the the waiting list
are actually people who fall into the coverage gap.
So it would help those individuals to be healthy enough
to be in the workforce and perhaps be providing those
exact services.
OK. And Bob, I'm going to have you weigh in
here.
First of all, let's talk about the larger debate over
the disability wait list right now.
And then can both issues do you think,
be addressed in one session,
in one session? Theoretically they could be.
It's really goes back to something I said earlier,
it's really, well, let me take one quick step back.
Federal government, they can borrow money,
you know, and they do.
And they have a huge debt,
trillions of dollars. State governments,
they have to have a budget.
If they go into debt,
you know, we're in trouble.
And Kansas has been through that,
the highs and the lows.
So really it's priorities. I mean sometimes the federal government
will say we got priorities,
but it's it's everything. But state governments really have to
have priorities
to the speaker's point of how much things cost.
And so it it goes back to what I said,
it's could a state do both and spend that much
money?
If that's their priority, they can,
but it's going to. Kansas tends to have very high
priorities.
At least going back about 15 years
for tax policies is a big one.
And that takes a lot of money
if that's the state's priority.
We've had some big tax cuts.
We're still talking about them now and they can cost
money.
And initially, even some years ago,
the argument was, oh, trickle down economics,
don't worry, this won't cost any money.
Kansas found out no, if
it does cost money, and that's fine if you're going
to cut taxes.
So right now, again, the the priority is not for
Medicaid expansion.
And you're right, there's been more movement,
you know, lately to try to get these lists down.
But they're very, very expensive.
They're probably going to cost more than we think.
But again, the culture of the state has to be
it's worth it
with tax cuts. That's almost always the answer.
Oh, this is worth it.
It's going to be great.
It's going to bring a new business,
and that's the the priority.
But other states will argue do that with healthcare.
All right, we'll be right back.
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Welcome back to Inside Kansas Politics.
I'm Rebecca Chung. We're wrapping up our discussion now.
And before we go, I want to talk about the
next steps because some people are skeptical about whether Medicaid
expansion will even come up for debate this year.
We still have that bill in the Senate.
Not much traction there. Bob,
what's your take? I was surprised there was hearings,
but I guess I'm a,
I'm a cynic.
I think the speaker can tell us best.
Hey, this is America. It's democracy.
It's it's politics and he can he can tell us
he's talked before about whether he thinks the votes or
not are there or not.
The governor claims they are
And so I defer to the speaker.
It it seems like there's there's other things this,
this year that need to be hammered out.
I think a lot of people would rather not see
a special session.
So I would say it's probably be quite difficult to
to to shoehorn that in the rest of this year.
OK And Speaker Hawkins, what are your thoughts?
Could we see this gain traction and if not,
what other proposals could make it to the governor's desk?
I think, I think today was indicative of what will
happen.
They, they worked the bill in committee,
in the health committee, in the,
in the House side. It failed.
It did not move out.
You know, the governor says that there's a vote there.
I know my body very well.
I count my votes all the time.
One thing that I am probably the best at is
counting votes.
And I can tell you there are not 63 votes
there.
There are not even 55 votes there.
So she can talk about
there being votes there. There's not
the Senate side. I don't,
I never tried to predict what the Senate's going to
do.
Believe me, I would love to,
but it I would be wrong
what what they're going to do.
So we'll let them decide on that.
I would say that we will continue working really hard
to
make sure the Medicaid reimbursement rates get through the budget
cycle.
We're still in the budget cycle.
We're not done yet. That's going to happen this next
week.
We'll have conference committees starting
to work on the budget and hopefully maybe by the
end of next week,
we will see that through.
And that really kind of gives us a good
look at where we're going to be at.
We still have one budget left at the very end
of session.
As Bob said, tax is the big thing
both on the governor's side and on our side.
We we feel like we do need to have tax
relief
and we're working very diligently on that Met with the
governor day,
I wouldn't say we made a lot of headway.
It was very it was just an interesting conversation we
had
with really neither side agreeing on much of anything.
So we got probably a long way to go on
that,
but the the
that will work its way out.
We're going to have tax relief before we leave.
So I think that's kind of where it ends up
really does OK. And something interesting that came up during
hearings,
they did say, you know they have the argument about
the disability wait list addressing that first before Medicaid expansion.
But they did also say,
you know, before we even talk about Medicaid.
So could they, I guess,
come up with a proposal for Medicaid expansion in the
future
then do you think, do you think this is an
issue that's.
Yeah, this year, another session.
Oh, guarantee it will. There's no doubt.
You don't even have to think about that
hearing, do you think? You know,
we've had a lot of hearings.
It was interesting.
April knows how many hearings we had.
You know, I started out,
I started out as health chair
and I had three days of hearing the first time
I did it,
three days.
So we've had hearings all the way along.
Have have we had
a bill make it out of committee into the floor?
Never, I don't think, I don't care.
I can't remember if ever a bill making it out
of committee of the floor,
How it comes to the floor is through an amendment
and we have debate and what's the interesting thing about
it is one time.
So I think it's probably 17.
It made it across the House floor,
made it through the Senate and to our Governor
Brownback at the time and he vetoed it.
The next time was in the 19 to 20 time
frame
when it made it across the House floor,
made it to the Senate and the governor had it
won.
She was winning. I always say she had us down
24 to 0,
kind of like the one of the games with the
the Chiefs. We were down 24 to 0 and she
decided to shift
her attention to value them both which she didn't have
any say in it but she made a big deal
out of it and made Susan Waggle
make the the
proclamation that she would never do Medicaid expansion until value
in both
one. And so the governor had the ability then it
was it was going she was it was going through
the Senate was going to head to the to the
governor and the governor just took her eye off the
ball
and so it would be here today.
If she hadn't done that,
you would agree. Well, I what I would do is
say that I think you were the last chairman in
the House that allowed
bill hearing on expansion. Yes,
it has not happened since 2017.
Time flies. It does fly when you're having fun.
There's been, there has been a round table back in
2019,
but the last time there was an actual bill hearing
was 2017 in the House,
April notes. I forgot that it went to Governor
Brownback's. I did. I forgot about that.
In in in back when back during that time
might know this might be just a little off script,
but I actually didn't know what he was going to
do.
There was some people that actually thought he might sign
it and some people thought he might veto.
Well, he ended up vetoing it,
but most people really didn't know what he would do.
So so classic the legislature passes it and the governor
vetoes it and then the the next governor wants it
and then the legislature doesn't pass it.
So, you know, that's a
little bit of history there.
Director Holman, what's your take?
Any final thoughts on this?
Yes, absolutely. We have 4 bills for expansion that are
exempt and alive until the end of this session.
We are not giving up as advocates for expansion,
even though I'm hearing that the odds are stacked against
us.
I would say that I really hope that as we
move forward,
we will find a way to be able to negotiate
some sort of compromise on expansion.
Certainly 40 states have already done this,
red and blue states. We are seeing the expansion past
the Republican House in Mississippi a couple of weeks ago.
This is a foregone conclusion that expansion is not going
away.
So when we look at our decision to turn this
money that would help us in a number of ways
in Kansas away.
I think we really need to think of ways that
we can find a solution that makes everybody comfortable
where we can help utilize those funds and do good
for our state.
But then it also still faces opposition in the Senate
as well from Senate Republican leaders.
So how do you see that going on that side
this year?
I think I I would respectfully disagree with Speaker Hawkins.
I think we do have the votes on the floor,
but we don't necessarily have votes to go against leadership.
And so where we have private conversations with legislators and
they say,
I know that my constituents want this,
but my speaker does not
and we're not going to be able to get it
to a vote
that gives me hope that there is an opportunity if
we ever were able to just have a clean vote
on the floor of the House or Senate.
And and the political side is the governor,
as as we all know,
has started a political action committee,
seemingly well funded is now begin.
They've announced some of the races they're targeting.
So Medicaid expansion, if it doesn't happen
as a bill this session,
it's going to be very prominent in the
2024 Kansas elections. All right.
Thank you all. And that was your look inside Kansas
politics.
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