Thursday, October 30, 2014

HAWVER: Whose hands are dirty on health care?

By MARTIN HAWVER, At the Rail | 3/25/2013

Maybe you’ve been around Statehouse politics the right amount of time when a floor amendment to a bill that sounds like it does one thing does it ... and a whole lot more.

That’s what happened last week when state Sen. Dennis Pyle, R-Hiawatha, got an amendment added to the Senate’s budget bill that bluntly states that not one dime of state money will be spent to expand the state’s Medicaid — now cleverly renamed KanCare — program without legislative approval.

Maybe you’ve been around Statehouse politics the right amount of time when a floor amendment to a bill that sounds like it does one thing does it ... and a whole lot more.

That’s what happened last week when state Sen. Dennis Pyle, R-Hiawatha, got an amendment added to the Senate’s budget bill that bluntly states that not one dime of state money will be spent to expand the state’s Medicaid — now cleverly renamed KanCare — program without legislative approval.

Pyle and a lot of members of the Legislature don’t want Gov. Sam Brownback to take up the offer from the federal government to expand by more than 100,000 the number of Kansans who qualify for federally paid health care. The deal: If Kansas expands eligibility for Medicaid, the federal government will pay the entire bill for health care for the first three years of the expansion, and then drop to paying 90 percent of the cost of that expansion.

It’s that fourth year that has conservatives scared: Hundreds of millions of dollars that Kansas will have to chip in for the continuation of that health care to the near-poor who don’t qualify for Medicaid now, but would under the expansion.

It’s the “anti Obamacare” arguments you’d expect, plus fears that the federal government might have to cut funding for that portion of the Affordable Care Act in future years. Decent argument, but Kansas health-care providers and hospitals are going to take care of those Kansans anyway, costing millions, forcing higher costs for insured Kansans to carry the load and likely leading to shut-downs of some hospitals. Oh, and of course, there are the uninsured near-poor people who would like health care.

The amendment? Pyle maintains that it means the governor can’t independently authorize the expansion of Medicaid and start spending the state and federal money to make it work.

He’s right. But the amendment also means that Brownback can say he is in favor of health care for the near-poor and can sign the state up for it, but nothing happens until the Legislature says it happens. That shifts responsibility for actually caring for the new Medicaid recipients to the Legislature — next year when Brownback and the Kansas House stand for reelection.

While it clearly gives the Legislature the final word on the expansion of services — and the conservative Legislature wants that final word — it also makes the governor’s decision almost inconsequential. He can say — we’re guessing it would be at a rally or press conference at which he mentions that he cares for the poor who need health care — that he wants that expansion…and wants the Legislature to make it work.

It makes Brownback the friend of hospitals, of the health-care community, and of the people who need that health-care coverage, and puts the Legislature on the line to make it happen ... or not happen.

Sound like a pretty good deal for a governor seeking election to a second term? Could be.

Pyle says he doesn’t want Brownback to take the Medicaid expansion offer. But, he has also provided the governor a way to show compassion for the poor who need medical care ... and put the Legislature on the block to make it work.

Martin Hawver is publisher of Hawver’s Capitol Report. Visit his website at www.hawvernews.com

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