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Medicaid expansion would not resolve all rural healthcare woes, supporters acknowledge

Apr 29, 2019

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Jonathan [email protected]


Apr 29, 2019 at 4:36 PM

PITTSBURG — Earlier this month, Gov. Laura Kelly doubled down on her previous calls to expand KanCare, the state’s Medicaid program, citing rural hospital closures.

In interviews last week when they visited Pittsburg, however, supporters of Kelly’s plan to expand Medicaid in the state acknowledged that doing so will not solve all of the problems rural hospitals face.

In late January, Gov. Kelly presented her Kancare expansion plan.

“It was a reasonable, common sense bill,” she said in early April. “By design it was very similar to the plan that passed the legislature in 2017 with strong bipartisan support. Since that day, leadership in both chambers has blocked the debate and the committee process, preventing action on this critical issue while rural hospitals struggle and in some cases close.”

As the legislative session winds down and legislators prepare to return May 1 from their spring break, pressure has built for a Senate vote on Kelly’s proposal, which passed in the House in March.

“I’m disappointed that Senate leadership continues to block any action on Medicaid expansion. No hearings, no vote, nothing but a request for an interim study on the issue,” Kelly said in early April. “I have always endorsed efforts to carefully study issues before taking any action, but when it comes to Medicaid expansion, ‘study’ is a code word for ‘stall.'”

At a Student Government Day event in Pittsburg last week, Kansas State Rep. Ken Collins (R-Mulberry), who voted against the House bill, and Kansas Sen. Richard Hilderbrand (R-Galena) answered student questions about the KanCare expansion plan and about student protesters who were temporarily banned from the Statehouse after unfurling banners accusing Medicaid expansion opponents of having “blood on their hands.”

In responding, Collins and Hilderbrand criticized the “gut-and-go” process that allowed the House vote on the KanCare bill, and said while they support students’ right to protest, there need to be limits on what people do at the Statehouse considering it is a historic building, and that students should be careful to obey Statehouse rules.

In response to an inquiry from the Morning Sun earlier this month Rep. Collins also brought up the recent closure of Mercy Hospital Fort Scott.

“In Fort Scott the figure that was given to me was around $14 million that the hospital had lost and that expansion of Medicaid would have only brought in around two million,” Collins said in an email. “That would not have saved that hospital.”

Supporters of Kelly’s KanCare expansion proposal, including Kansas State Rep. Monica Murnan (D-Pittsburg) and Lt. Gov. Lynn Rogers, were also scheduled to appear at the Student Government Day event but didn’t make it. Both discussed Medicaid at other events in town, however, on the same day. Lt. Gov. Rogers made several stops in Pittsburg as part of a “Rural Healthcare Tour,” with Murnan also appearing.

Two Kansas hospitals that closed in recent months —Horton Community Hospital and, closer to Pittsburg, Oswego Community Hospital — were until recently operated by EmpowerHMS, a company that is being sued for allegedly fraudulent billing practices.

“But that company was important to Horton,” Murnan said in an April 23 interview at Community Health Center of Southeast Kansas, where Rogers was touring the facility as part of his Rural Healthcare Tour.

Both the Oswego and Horton hospitals are under investigation by the office of the Kansas Attorney General, although the AG’s office declined to say earlier this month whether its Medicaid Fraud and Abuse Division was involved in the investigation.

“Nobody believes that every hospital is going to be totally fixed with Medicaid expansion,” Murnan said last week. “But the numbers are clear. Medicaid expansion does support the infrastructure of rural hospitals and big hospitals, and the Kansas Hospital Association can provide specific information on every hospital. Now do individual local hospitals have their own other financial issues? Absolutely. But nobody’s ever said this is going to fix everything, but it sure would help.”

Asked about Kelly’s invoking the closures of rural hospitals in promoting her Medicaid proposal, Rogers similarly said that “one of the things we want to make sure we stress is that we don’t think it saves rural hospitals in and of itself, but it is something that all four hospitals that have closed have indicated that it does impact and has impacted their conditions and it would have made, you know, particularly in Horton it would’ve let them pay payroll for the last, you know, 30 days.”

Eighty-five percent of Kansas hospitals “are operating on a negative net worth, and so that’s a scary figure when you think of, you know, if you don’t make money, if you have a negative operating margin, you’re not going to stay in business forever,” Rogers said.

“Hospitals gave up reimbursement levels when the Affordable Care Act was passed under the assumption that everybody would have insurance. Now you can never deal with fraud or mismanagement, but you know, the rest of the hospitals that we have here it does have a big impact and it would make a difference of keeping the hospital in place. And if you want to lose a hospital and you have to go another 30 miles, that’s really tough when you’re having a heart attack, you know. Those are tough things.”

Murnan additionally commented on prospects of the Medicaid expansion plan passing in the Senate as the legislature returns from its April adjournment on May 1.

“I believe that through this break, a lot of people from communities who typically are not politically active have made a concerted effort to let their senator know their thoughts, and I think that’s a good thing,” Murnan said. “No matter how it turns out, if the debate happens, that’s a good thing, and that’s what I’m hoping for right now is the debate on the Senate side, and that the senators can vote, and we hear the facts, and people get their say, and the process works.”

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