The Wichita Eagle, May 2
Expand KanCare now:
As state legislators sit around and wait for that elusive budget solution to appear, they should consider the serious consequences of their continued failure to expand Medicaid in Kansas.
Kansas hospitals and other medical providers have pleaded with state leaders to expand KanCare, Gov. Sam Brownback’s privatized Medicaid delivery system. They note that other changes under the Affordable Care Act are reducing their payments and putting some facilities at risk of closing, that expansion would bring $2.2 billion in federal funds to the state through 2020, and that other states have found ways to expand that reflect free-market principles.
A new poll indicates that 64 percent of Kansans, 58 percent of Kansas Republicans and 63 percent of Wichitans support expansion, which would raise eligibility to 138 percent of the poverty line, or less than $33,000 in annual income for a family of four.
And last week another powerful voice made itself heard.
The Catholic bishops of the state said “many of our brothers and sisters who cannot currently afford health insurance would gain access to it, bringing an end to the uncertainty and fear that the uninsured of our society must live with daily.” Reminding state leaders of the parable of the “good Samaritan” found in Luke 10:29-37, the bishops observed “that the measure of a culture is the manner in which it provides for its weakest and most vulnerable.”
But long-sought House hearings on expansion recently led nowhere. Though the room was packed with proponents, what prevailed were a state official’s fearmongering testimony about costs to the state and a national Americans for Prosperity representative’s threat that AFP would “hold accountable any legislator who supports this misguided scheme.”
The truth is that the federal government will pay 100 percent of the cost of expansion in 2016, then scale back its contribution to no less than 90 percent by 2020. And the Brownback administration inflates the state’s potential expenses by folding in the cost of taking disabled Medicaid beneficiaries off the waiting lists for in-home support services a separate issue from KanCare expansion.
The value of expansion extends beyond money for the 150,000 uninsured Kansans, including many who work at jobs without benefits. As Robert Moser, Brownback’s former Kansas health and environment secretary, testified: “Access to care in turn translates to healthier families and a healthier workforce.”
Such common sense and compassion may be no match for the shamelessness of the opposition, as seen in Tennessee earlier this year. Though Republican Gov. Bill Haslam had spent two years crafting an expansion plan, the Koch-funded Americans for Prosperity killed it in committee in three days, vilifying and scaring lawmakers with radio ads and mailings linking the plan to President Obama.
“The problem hasn’t gone away,” Haslam later told USA Today. “We still have people who need insurance.”
So does Kansas, which a Gallup study named as the only state to see its uninsured rate rise last year.
If lawmakers listen to their constituents, rather than AFP’s threats, they will demand that the governor and legislative leaders act in the best interests of Kansas’ hospitals and uninsured. That means expanding KanCare.
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The Hutchinson News, May 1
Medicaid carrot:
State officials who don’t want the federal government’s money to expand their Medicaid health-insurance programs for low-income residents shouldn’t mind if the feds also stop sending money to their hospitals to subsidize them for uncompensated care.
Or they could instead see the logic in expanding Medicaid. It is far better to cover health insurance than to bail out hospitals for the charity care they have to deliver because so many people are uninsured.
The Obama administration is using a little more leverage on hold-out states refusing to accept the Medicaid expansion offered under the Affordable Care Act by withdrawing money going to hospitals from the so-called Low Income Pool, also known as LIP.
Texas and Florida were the first of the nine states that haven’t expanded their Medicaid programs to be presented with this carrot - or stick, depending on one’s viewpoint. Both have large numbers of uninsured and get billions from the LIP.
The warning was extended to Kansas last week. Kansas Medicaid officials said they received about $45 million this year from the LIP, which began in 2013 and was to continue through 2017, reported Kaiser Health News. Contrast that with the projected $5.3 billion Kansas is projected to receive over 10 years if it expands Medicaid.
Clearly, Kansas should take the Medicaid expansion. The LIP money is relatively inconsequential by comparison.
States that have expanded Medicaid no longer need the LIP, and it seems strange to continue with a federal subsidy program that doesn’t fix anything with the system, just for the benefit of states who want to make a political statement about “Obamacare.”
Republican leaders in these states are crying foul over what they perceive as a threat. But the federal government has complete discretion with grants from LIP. That much and more is available through Medicaid expansion for states willing to put aside politics and focus federal program dollars at the core problem - too many uninsured people.
Kansas lawmakers should look at this as one more reason to expand Medicaid in our state and extend coverage to an estimated 140,000 to 170,000 uninsured Kansans. Insure them on the front end rather than fighting to protect federal hospital subsidies on the back end.
Kansas hospital officials should make some more noise here, too. They already are suffering for state government’s obstinance on Medicaid.
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Lawrence Journal-World, May 3
Shameful report on sexual offender program:
In an effort to protect Kansas residents, the state passed legislation in 1994 designed to confine people who had committed violent sexual crimes until they no longer were a danger to the public.
Perhaps, because of mental illness or other issues, some of those offenders would never meet that standard, but with proper therapy or medical intervention, it seemed likely that a sizable number could be released without posing a danger.
Now comes a report from the Legislative Division of Post Audit indicating that in the 20 years of this program’s existence only three people have been released. Far more, 27, have died in custody. A total of 258 offenders currently are in the program, which cost the state about $13.9 million last year. Unless changes are made, the audit said, both the size of the program and the cost to maintain it will more than double in the next decade to about 500 patients and between $26 million and $34 million by 2025.
The rising cost of the program gets legislators’ attention, but the human toll may be even larger.
The 1994 law provides for offenders to be involuntarily committed to a state facility after completing their prison sentences. Currently all of the offenders being treated are men. Most of those, 243, are at Larned State Hospital; facilities at Parsons and Osawatomie each have eight patients.
The audit compared the Kansas program with similar programs in Wisconsin, Washington and Iowa. The Wisconsin program, also established in 1994, has a current population of 312, but, since its inception, it has conditionally released 122 people and unconditionally discharged 118 people. Long-term data on those who are released committing new offenses isn’t available, the audit report said, but Wisconsin recently started to capture data that estimates its rate for re-offenses was between 3 percent and 5 percent.
In order to be released from the Kansas program, offenders must complete a seven-phase treatment plan. That’s a difficult goal when patients, according to the audit, receive fewer than three hours of therapy a week, much of it not tailored to their individual needs. Records of patients’ progress also are insufficient the audit says. State statute requires an annual exam of each resident’s mental condition to determine whether that person still meets the requirement for a involuntary commitment, but those exams haven’t been completed at Larned. Unlike sexual predator programs in other states, the Kansas program offers no GED or adult basic education programs and no treatment for drug and alcohol addiction. According to the audit, “staff said the program was not designed to provide rehabilitation such as addiction recovery services.”
Without rehabilitation, therapy or even proper evaluation, what is this program other than a way to warehouse people indefinitely, not meeting the intent of the original law and perhaps violating their civil rights?
Kansas and its Menninger Clinic once prided itself on progressive treatment of mental illness. About a decade ago, it also was known as a leader in rehabilitating prison inmates and successfully returning them to society. The audit report on the state’s sexual predator program should make state officials ashamed. If there are people in this program who can never be rehabilitated, the state should admit that and find another way to properly confine them. But those who might be able, with proper therapy and education, to re-enter society deserve better. The state has a moral and legal obligation to provide a program that gives them that chance.
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Salina Journal, May 3
That’s none of your business:
Kansas Attorney General Derek Schmidt on Tuesday (May 28) said that public officials in Kansas can conduct public business on private email accounts without those emails becoming public records.
Say that slowly: Public officials. Public business. None of your business.
The matter Schmidt referred to goes back to before the start of the legislative session when state Budget Director Shawn Sullivan used a private email account to send copies of the proposed state budget to a few administration officials … and two former state officials, lobbyists David Kensinger and Mark Dugan. Kensinger is Brownback’s former chief of staff, while Dugan is a former campaign manager.
They got a look at the proposed budget about three weeks before legislators did.
According to a story in the The Wichita Eagle, Kansas law considers “any recorded information, regardless of form or characteristics,” to be a public record if it is made or maintained by a public agency. However, Schmidt said, state employees such as Sullivan are not a public agency. If they use their state email account, then what they send is a public record. If they use a private account, even though it’s state business, we’re in the dark.
In about half the states, Sullivan’s private email account would be considered a public record.
Senate Minority Leader Anthony Hensley, D-Topeka, who sought Schmidt’s opinion, said it was highly inappropriate for lobbyists to be given a look at the budget before lawmakers. We agree.
For his part, Sullivan said he used his private email only because it was done while he was home for Christmas.
When asked why two lobbyists were allowed to look at the budget before legislators, Brownback spokeswoman Eileen Hawley said: “I think you’re digging to find things that aren’t there . we sought the counsel of a lot of people in that process.”
We’re sure the governor did consult a lot of people. But including lobbyists - even former aides - ahead of legislators can do nothing but needlessly create suspicion, which only makes it more difficult to govern.
Beyond that, the Legislature needs to fix the loophole that allowed this to happen. Transparency shouldn’t depend on which email account is used.
When it comes to public officials, and public business, it’s our business.
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