The Senate Health Care Bill is Harmful to Rural Kansas

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.