RX for Change: Confronting the health care crisis in Kansas

Dec. 8, 2005

By SARAH KESSINGER

Harris News Service

Kansas legislators might agree on little these days, but they do find common ground when it comes to pushing prevention to rein in state medical costs.

Several states are waging campaigns to encourage healthier lifestyles among residents. Kansas lawmakers last session took a leap onto that bandwagon.

Sen. Jim Barnett, an Emporia physician who recently announced he would seek the Republican nomination for governor, authored a new law last year that requires the state to help schools offer healthier foods in lunchrooms and vending machines. It also encourages broadening physical activity programs for students.

Prevention and wellness efforts are key to long-term affordable health care, Barnett said.

“We also need to look at how we're prescribing medications, how we order tests and also tort reform.”

Sen. Janis Lee, D-Kensington, plugs Gov. Kathleen Sebelius' year-old Healthy Kansas initiative for its efforts to promote wellness. Through it, the Kansas Department of Health and Environment began to network with local agencies and organizations in stepped-up efforts to prevent poor health.

“Losing weight, not smoking, being active, if we can instill that in our children over the long term we can make changes for the better,” Lee said. “It's just a matter of helping people understand and getting our kids active as opposed to sitting in front of a TV or video games all day.”

Barnett also pushed for more teen smoking prevention efforts, which subsequently gained twice as much state funding this year.

“I don't think there's a simple answer to that but there are surely models we can try,” he said.

If the state fails to address it, he said, “we will see a continued increase in chronic illness with an uncontrolled cost of health care.”

Rep. Melvin Neufeld, R-Ingalls, and other legislators tend to drop jargon like “disease management” into explanations of how the state might help the sickest Kansans, who are often also the poorest, learn to eat healthy foods, remain active and take medicine as prescribed.

With proper daily care, patients don't tend to land in expensive hospital beds with complications from diabetes, asthma and other chronic illnesses.

Neufeld and other lawmakers suggest the state could do more to help county health departments work with local residents who have chronic disease and assure they get to medical and dental appointments.

“We'll have to enable health departments to have a stronger role because they are the ones that provide a lot of early intervention and prevention,” said House Minority Leader Dennis McKinney, D-Greensburg. “They're out in the trenches with a lot of working poor people who can't afford health insurance.”

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In addition to health promotion, Kansas lawmakers are taking an in-depth look at Medicaid's cost-drivers this fall and plan to have various proposals on the table by session time in January.

While some states are cutting back on Medicaid's insurance to the poor and disabled, others are expanding it to assure the public is covered. Congress, meanwhile, is embroiled in a debate over proposed cuts in Medicaid dollars for states.

The potential loss of federal dollars plus rising costs for care force all states to look for long-term budget control strategies.

“I certainly do not want to see the state of Kansas reduce or eliminate service for any Kansan in need,” Barnett said. “But we do need to know how we spend our money. I have no doubt in my mind that fraud and abuse occurs. I think it's hard to get a handle on how much is present, but I sense we're not overseeing things as well as we could.”

Senate Majority Leader Derek Schmidt, R-Independence, suggests the state needs an independent inspector general to continually review expenditures in the $2.2 billion federal-state Medicaid program. It is slated to cost $3.3 billion by 2011 if left unchecked.

“That's such an enormous sum of money, with so many actors involved and so many moving parts that you have to have constant monitoring in order to identify opportunities for efficiency,” said Schmidt, chairman of this fall's Medicaid task force.

Also, parts of the state, particularly in dental care, offer no Medicaid support to poor families, including many children.

Reimbursement to doctors, dentists and other caregivers in Kansas is low enough to discourage several from accepting Medicaid patients.

In light of that, finding savings will be tough, McKinney said. Kansas already is one of the leanest states in the nation when it comes to offering Medicaid to adults.

“We've certainly not thrown money at Medicaid,” he said. “It's still easier to qualify for Medicaid in Missouri now, after their cutbacks, than it is in Kansas. We have extremely tight eligibility rules in Kansas. And caregivers have to run a pretty tight ship.”

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Though costs have risen dramatically not only for Medicaid but also for state employee insurance and prison health care, state lawmakers hesitate to seek new revenues to cover them.

The governor proposed a cigarette tax hike last year to expand Medicaid to more working parents. But lawmakers ignored the proposal.

McKinney said the tax pitch likely failed because lawmakers had raised tobacco taxes a few years earlier and they tend to hesitate on any tax hike for fear of election backlash.

The state should help subsidize businesses, he said, so they can afford to provide co-insurance.

“We're up to 300,000 uninsured and 150,000 of those are working poor,” McKinney said. “Those people actually are in the workforce.”

As for Medicaid costs, Schmidt's task force is looking at charging higher co-payments for enrollees as one way to cover more of the cost.

Some lawmakers, too, prefer a system of Medicaid participants managing their own allotment of aid, taking responsibility for how it is spent but getting only a capped amount.

“I think this idea of looking toward private accounts, even if it's on a pilot basis, is one that we need to explore,” Schmidt said. “It does get folks riled up because it is so contrary to the way the system works now.”

But, Schmidt said, there's little point in “nibbling around the edges.”

“We're going to have look at systemic change.”