By State Rep. Blaine Finch, 59th District, Franklin and Osage Counties
Greetings to all of you. This week we dealt with the override vote on HB 2044 commonly known as Medicaid expansion. I heard from many people on this issue and I wanted to devote this column to sharing my thoughts on this important issue.
Let me begin by saying that I think there is some confusion about what this bill is about. Some have made this an issue about Governor Brownback. I have never voted on a bill based on where the governor – or any other politician – stands. I have consistently stood up to the governor and fought back against the unsound tax policy that has left our state mired in deficits. Just three weeks ago I voted to override his veto of a tax plan that would have ended his experiment and started us back on a path to solvency. So my decision on this bill was not about the governor. It was about us, the people who live in this district, about making sure we enact sound policy that makes promises we can keep and that doesn’t end up doing more harm than good.
I believe it is critically important that we make sure Kansans have access to health care. Whether young or old the ability to get medical help is essential to the good health, longevity, and productivity of our friends, neighbors and fellow Kansans. I support health care for Kansans so why couldn’t I support this bill?
First, this bill expanded care for one group of people while resources to help other groups remained stagnant. Note that no one lost their Medicaid coverage because this bill was not passed. Expansion under HB 2044 applies only to non-disabled adults who make 100 percent to 133 percent of the federal poverty level. In Kansas, we already cover children to 244 percent of poverty level; pregnant women to 138 percent of poverty level; and those over 65 or who are disabled to 138 percent of poverty level. This bill would do nothing to improve services for those most vulnerable groups, some of whom are on waiting lists for services such as the home and community based services (HCBS). For example, many of our COF consumers must wait on these lists until there are resources approved to help them. Passing HB 2044 would have prioritized resources for the non-disabled adult population – including those who have private insurance – over Kansans with disabilities who continue to wait for services.
Second, this bill made promises that the state likely cannot keep. Expansion was estimated to cost more than $70 million at the outset and if estimates were off – which they have been in almost all states that have expanded – the cost per year to taxpayers could have been double that. Given our state’s financial situation – and the Governor’s practice of blocking the tax reforms we’ve passed – we would likely be unable to fund the state’s portion of expansion. That would have meant a broken promise to those who were given the hope of coverage only to see it dashed. The state of Arkansas saw the introduction of a bill this year to cut off enrollment in their expansion program because their estimates were so far in error. Creating a situation where we promise coverage and do not deliver, or where some are given coverage and others in the same situation are denied, is simply unconscionable to me.
Finally, and very significantly is that the state simply does not have the available funds to pay for expansion. Kansas is currently more than $200 million in the hole for this fiscal year. We will be over $500 million down in Fiscal Year 2018, which begins on July 1 of this year.
We still have the court’s decision in the school finance case which could cost between $150 million and $400 million this coming year. If we fail to leave an adequate ending cash balance, more power shifts to the governor, allowing him to make allotments, or cuts, without legislative oversight. Last year, cuts were made to the Medicaid reimbursement rate. This caused more doctors and healthcare providers to scale back on the number of Medicaid patients they could see because they received less money for doing so. In short we would have invited more people into the pool of Medicaid coverage while creating a hole in the bottom of the pool and draining the coverage around them. That is not acceptable.
Other states have chosen to expand with provisions in their bills that require the expansion to be budget neutral; that require the use of health savings accounts so those who can pay something for their health care are asked to do so; and provisions that require cost containment and the use of preventative care to avoid bigger health care bills later. This bill did not have any of those provisions and I could not support it.
I am committed to working with lawmakers, our health care providers, our hospitals, health foundations and others to develop a solution that our state can afford and that doesn’t make false promises to those in need. We need – and our fellow Kansans deserve – a plan that will really work, that doesn’t favor one group over another, and that can provide access to health care in a way that is compassionate and fiscally responsible.
I welcome your emails or calls on any issue that is important to you. You can reach me at 785-296-7655 or firstname.lastname@example.org.