For most of
my professional career, now more than 30 years, I’ve worked to develop
sustainable health systems that provide access to quality, affordable care in
rural areas. I’ve visited hundreds of
small communities in Kansas and across the country, working with local residents,
health care providers, and policymakers to find solutions for increasingly
fragile health care systems.
During this
time, I’ve had the privilege to be involved in some of the most important rural
health programs of recent decades, including developing and implementing Critical
Access Hospitals (CAHs), which form the backbone of the health system across
much of Kansas and rural America.
So, I am alarmed
by the Better Care Reconciliation Act of 2017 (BCRA), now being fast-tracked
through the U.S. Senate. This legislation
would do great damage to rural health and rural communities.
Although promoted
as repeal and replacement of the Affordable Care Act, BCRA is really an attack on the Medicaid
program, known as KanCare in Kansas. Medicaid
has provided health coverage to children, pregnant women, individuals with
disabilities, and low-income seniors for more than 50 years. BCRA would cap it and cut it, slashing funding
by more than 25% over the next decade. In
Kansas, this will amount to a reduction of more than $1 billion.
The cuts
will accelerate and grow over time. The
Congressional Budget Office (CBO), the non-partisan agency charged with
analyzing federal legislation, estimates that Medicaid spending will be 35%
less over the next 20 years if BCRA becomes law.
These cuts
will be especially harmful to rural Kansas.
A recent study by researchers at Georgetown and the University of North Carolina shows
that Kansans living in small towns and rural areas are increasingly reliant on KanCare
for their health coverage. Thirty-six
percent of children living in non-metro areas of Kansas are covered by KanCare,
compared to 27% of urban kids. In
addition, the proportion of children in KanCare is rising faster in rural areas
than urban communities.
Medicaid
also covers a higher percentage of Kansas adults living in small towns and
rural areas (9%) than in the state’s metro areas (7%). Many of them are parents and caregivers and,
in addition to health coverage, Medicaid provides financial protection for
these families against medical debt and bankruptcy.
But even
Kansans who don’t rely on Medicaid should be concerned about the impact deep
cuts will have on rural hospitals. More
than a third of Kansas’ rural hospitals are financially vulnerable. Reductions in KanCare coverage and payment
will quickly push local communities into wrenching decisions about increasing taxes
to support the hospital or seeing its doors close. When a rural hospital closes, it’s not just
health care that’s affected. Employment
and the economic vitality of the entire community suffers.
Rural
nursing homes will experience a similar fate.
Most nursing home residents rely on KanCare. In fact, although most KanCare enrollees are children,
70% of the program’s funding goes to care for seniors and Kansans with
disabilities. Program cuts will hit
them, and their providers and caregivers, the hardest.
Rural schools,
many of which face an ongoing funding crisis, will be affected, as well. Kansas schools receive Medicaid funding to
provide services to special needs children.
This funding is at risk under the Senate health bill.
Beyond
slashing Medicaid, BCRA will eliminate guarantees that health insurance plans
cover a comprehensive range of services.
Rural residents, who are more likely to suffer from heart disease,
cancer, respiratory disease, unintentional injuries, and stroke, may once again
be barred from the insurance market because of pre-existing conditions.
The bill
will also dramatically reduce financial assistance for purchasing health
insurance, particularly for older and lower-income Americans. Many farmers, ranchers, and other rural
Kansans who have been able to buy insurance over the last few years will no
longer be able to afford it.
Kansas
missed an opportunity to improve its rural health system when Governor
Brownback vetoed a bipartisan bill to expand KanCare during the recent
legislative session. Rural residents and
health care providers cannot afford another setback.
Throughout
their Congressional careers, Senators Roberts and Moran have been ardent
supporters of rural Kansas. They should
not forget these communities when BCRA comes up for a vote.