Cassidy-Graham is like previous Affordable Care Act repeal bills. It will hurt Kansans.

Over the spring and summer, four different bills to repeal the Affordable Care Act were voted on by members of Congress. All were deeply unpopular with the American public and failed in close votes.

These bills would not have delivered on politicians’ promises of better and less expensive health insurance plans and expanded coverage. Instead, they would have resulted in tens of millions of people losing their insurance, sharp price hikes in the next few years for everyone else, and the elimination of popular consumer protections such as prohibiting insurance companies from excluding people with pre-existing conditions from buying policies.

Now, in a last ditch effort to repeal the ACA by September 30, the end of the federal fiscal year, Congress is back with another destructive bill. Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina have introduced legislation that, like its failed predecessors, will result in coverage losses, higher costs, and elimination of consumer protections. Over the long term, the Cassidy-Graham bill may well be the worst one of all.

Cassidy-Graham would pool the federal dollars the residents of each state receive for financial assistance to purchase health insurance and send those funds to the states in temporary block grants. Included in these fixed block grants would be money states receive for expanding their Medicaid programs to cover more people. Kansas has not expanded its Medicaid program, known as KanCare, and has not received this enhanced funding.


The block grants would come with few strings. States would not have to use the funding to provide financial assistance to insurance purchasers. National consumer protections would be eliminated and each state would be responsible for deciding whether insurance companies could charge higher premiums to those with pre-existing conditions.

In addition, the guarantee that insurance covers a minimum set of benefits, such as hospital stays and physician care, would be eliminated. Again, states would decide which, if any, services must be covered and which are optional.

If Cassidy-Graham passes, insurance rules would resemble those that were in place before the ACA, when tens of thousands of Kansans with pre-existing conditions could not afford coverage and women could not purchase a standard policy that included maternity care.

Block grants would not increase at the same rate as insurance premiums, so each year consumers would see their financial assistance decline as prices go up. Block grants also do not respond to actual conditions on the ground, so if a recession occurred and the need for assistance increased, the block grant would remain the same. In the event of a natural disaster, such as Hurricane Harvey or Irma, or a tornado that devastates a Kansas community, there would be no additional funding to assist those in need.

And then, after 2026, the block grants would end. States would fall off a funding cliff in which federal financial assistance stops. The state would then be on the hook to replace the funds or see tens of thousands of residents lose their insurance coverage because they could no longer afford the premiums without financial help.

In Kansas, this funding cliff would result in a drop of more than a billion dollars in one year, according to an analysis by the Center for Budget and Policy Priorities.

But Cassidy-Graham does not stop there. Like the previous bills, it would slash funding for the KanCare program. Most of the Kansans who receive coverage through KanCare are children. Most of the program’s spending goes to the care of seniors in nursing homes and individuals with disabilities. Cuts to KanCare mean cuts to services for these populations. Additional thousands could lose their coverage.

Cassidy-Graham was introduced just last week and has not had a single hearing or debate. There has not been sufficient time for independent analysis by experts and by the clinicians and patients who would be directly affected by the proposed changes. Consideration of the bill has diverted time and attention from an ongoing bipartisan effort to stabilize the insurance market, increase competition, and reduce prices.

It’s time for Congress to stop playing politics with the lives and health of Americans. This bill must be stopped in the Senate. We urge Sens. Roberts and Moran to protect Kansans and stand firmly against Cassidy-Graham.

Coauthored with former Kansas Insurance Commissioner Sandy Praeger for publication in the Kansas City Star: http://www.kansascity.com/opinion/readers-opinion/guest-commentary/article174328721.html 

Read more here: http://www.kansascity.com/opinion/readers-opinion/guest-commentary/article174328721.html#storylink=cpy

Read more here: http://www.kansascity.com/opinion/readers-opinion/guest-commentary/article174328721.html#storylink=cpy

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. 

Separate is Not Equal in Education. Or Health Care.

We conclude that, in the field of public education, the doctrine of "separate but equal" has no place.  Separate educational facilities are inherently unequal.

- U.S. Supreme Court in Brown v. Board of Education, May 17, 1954

My office sits about a mile from the Monroe School, an historic, if not well known, place.  Monroe was once one of four segregated African-American elementary schools in Topeka.  Today, it is the location of the Brown v. Board of Education National Historic Site, commemorating the landmark U.S. Supreme Court decision to end racial segregation in public schools. 

As all schoolchildren are now taught, a unanimous court ruled in Brown v. Board that separate is inherently unequal.  Unfortunately, many adults – some who have seats in Congress and the state legislature – have still not learned this lesson. 

The American Health Care Act (AHCA), which has passed the U.S. House and is now being rushed through the Senate, proposes to segregate the sick from the healthy in insurance pools, creating separate and inevitably unequal coverage. 

As we strive to develop a health care system that works for all of us, we should not forget the lessons of Brown v. Board.

Prior to the Affordable Care Act (ACA), individuals with pre-existing conditions could have a difficult time finding health insurance.  Some would have to pay more or buy plans that excluded coverage of their condition.  If they couldn’t afford it, they would often go uninsured. 

Others were locked out altogether.  People who suffered from cancer or other serious conditions could not buy insurance at any price.  For them, many states – including Kansas – created special insurance programs, called high-risk pools, that segregated the sick from the well.

The idea was that sick people drive up costs for everyone else.  By segregating them, insurance premiums for the healthy would be lower. 

The problem was that concentrating those with pre-existing conditions – the people who arguably need health care the most – created insurance ghettos that were enormously expensive.  State subsidies were invariably inadequate and the result was very high premiums and deductibles and low annual coverage limits and lifetime caps.  Few of the uninsured could afford to participate. 

Separate was not equal.

The ACA ended high-risk pools.  It requires insurers to sell policies to everyone and prohibits charging the sick more than the healthy.  As a result, thousands of Kansans with pre-existing conditions have been able to find coverage.  Many now receive treatment for long-standing health issues.  Others are able to receive primary and preventive care, perhaps for the first time.  Lives have been improved.  Some have been saved.

Unfortunately, the AHCA will unravel this coverage guarantee and bring back health care apartheid.  It will allow states to waive protections for people with pre-existing conditions, as long as alternatives, such as high-risk pools, are established.  Predictably, proposed funding for these pools is grossly inadequate. 

You don’t need to be a health care expert – or a Supreme Court justice – to know how this will turn out.  Sky-high premiums and deductibles will make high-risk pools unaffordable for many of the people who are segregated from the insurance market.  They’ll no longer get the care they need.  Their health and well-being will suffer.  Some will die.  We’ve already lived this history.

By overturning the legal basis for segregation, the legacy of Brown v. Board extended far beyond public schools.  It provided energy to the voting rights and civil rights movements.  It inspired the Americans with Disabilities Act.  It continues to inform and encourage us as we work to create a society that offers equal accommodation and equal opportunity for all. 

A visit to the Monroe School quickly demonstrates why it would be unthinkable to bring back segregation in public schools.  It should be equally unthinkable in health care.

This was first published in the Topeka Capital-Journal on June 20, 2017

The AHCA and KanCare: Plan will harm vulnerable Kansans, state budget

The American Health Care Act (AHCA), passed by the U.S. House of Representatives on May 4, 2017, will profoundly change Kansas’ Medicaid program, KanCare. The bill is currently under fast track consideration in the U.S. Senate.

For more than 50 years, Medicaid has been a health coverage safety net to the most vulnerable Americans – mostly low-income children, seniors, and individuals with disabilities. Costs are shared by the federal government and the state government and are based on the needs of patients. Three-quarters of KanCare enrollees are children and families and 70 percent of the program’s dollars are spent on care of seniors and Kansans with disabilities.

The AHCA threatens to change that. It would impose caps on federal spending, shifting the risk for covering growing costs to the state. The federal contribution would increase less each year than the actual cost of care, squeezing the state budget more and more over time. The state will lose the ability to respond aggressively to health crises, cover new breakthrough drugs, and meet other needs that require flexibility and funding.

Nationwide, the AHCA will reduce expected federal spending on Medicaid by $830 billion over the next decade.  At least $1 billion of this cut – or about $100 million per year – will come from Kansas. The state will then face an inevitable choice – raise taxes or shift dollars from other programs to make up the difference. Or most likely, cut eligibility and benefits.

That means fewer kids with health coverage. Pregnant women who can’t get prenatal care. Less funding for seniors in nursing homes. And cuts in services to Kansans with disabilities. Because Medicaid covers the most vulnerable Kansans with the greatest needs, they are the ones who will be hurt when the state is forced to make do with less. In turn, there will be increased pressure on local communities and health care providers to fill in the gaps.

These Medicaid cuts won’t save much money. Instead, they’ll be used to deliver tax cuts to the wealthiest Americans. Tax cuts funded on the backs of low-income children and others who rely on Medicaid.  

The AHCA will harm KanCare and the Kansans who rely on it in other ways, as well. It will create bureaucratic barriers to enrollment and coverage. It will lock in the state’s relatively low program financing. And it specifically prohibits the state of Kansas from expanding KanCare, ensuring that Kansas taxpayers will continue to pay the tab for expansions in 31 other states without being able to bring our federal tax dollars back home.

The AHCA is being rushed through the Senate with no plans to hold hearings or gather testimony and public input. Kansans and all Americans deserve better.


This blog entry was originally posted by the Health Care Foundation of Greater Kansas City:  https://hcfgkc.org/kansans-deserve-better-ahca-offers/

Health Care Truth

This was published as a Letter to the Editor of the KC Star on May 20, 2017 (http://www.kansascity.com/opinion/letters-to-the-editor/article151640477.html)

Rep. Kevin Yoder used banal clichés such as “patients over bureaucrats” to defend his vote for the American Health Care Act in his May 10 commentary. (13A, “American Health Care Act will lower costs, offer choice”). But this bill would take coverage from Kansans and strain the state budget.

The AHCA would take nearly $900 billion from Medicaid over the next decade to pay for tax cuts for the wealthy. Medicaid covers mostly children, seniors and individuals with disabilities. They would be hurt when the state is inevitably forced to make do with less.

The AHCA would remove the guarantee of coverage for those with pre-existing conditions and allow states to experiment with other approaches. But the bill does not adequately fund these alternatives. Some, such as high-risk pools, have been tried in the past and failed.

There’s a reason no prominent health provider or patient organizations support this legislation. It hurts patients, providers and communities and takes us backward. Kansans are counting on Pat Roberts and Jerry Moran and their colleagues in the Senate to do better.

Read more here: http://www.kansascity.com/opinion/letters-to-the-editor/article151640477.html#storylink=cpy

Read more here: http://www.kansascity.com/opinion/letters-to-the-editor/article151640477.html#storylink=cpy