Former Kansas Gov. Kathleen Sebelius, back near home turf as the nation’s top federal health official, said she would have welcomed the federal health

reform dollars that have drawn little interest so far from the state’s current political leaders.

“I would’ve loved to have had the offer to have newly eligible Kansans be able to enroll in Medicaid,” said Sebelius, secretary of the Health and Human Services Department, which is leading implementation of the Affordable Care Act, commonly referred to as Obamacare.

“The money is available to help get people insurance coverage, have a health home, (and) get preventive care,” she said, briefly talking to reporters after a closed-door meeting at the Kauffman Foundation Conference Center with a variety of local health care leaders, business representatives, and safety-net officials. “And I’m hoping that both the Kansas Legislature and Missouri Legislature look at that offer again, and when they reconvene in January, make different decisions.”

Under the health-reform act, the federal government has offered to pay the full costs of the Medicaid expansion for three years in states that increase eligibility for the program to those earning up to 138 percent of the poverty level. Cost sharing would then gradually be reduced to a 90-10 federal/state split.

Current guidelines

Under current guidelines in Kansas, only those with children and incomes less than 32 percent of federal poverty guidelines can qualify. In Missouri, eligibility extends only to families at no more than 19 percent of the federal poverty level.

In Kansas, estimates are that a Medicaid expansion would cover about 240,000 additional residents, about equal to projections in Missouri.

During this year’s legislative session, Missouri lawmakers talked about expansion in the context of making cost-saving reforms to the program.

Republican leaders in the General Assembly appointed various committees to study the issue before reconvening next year. One of the committees reported earlier this month that the testimony it gathered indicated Missourians want to see Medicaid expanded.

In Kansas, members of the Republican majority, including Gov. Sam Brownback, have expressed doubt that the federal government can afford to make good on its promise to cover such a large chunk of the Medicaid expansion.

Sebelius said she continues to talk with officials in states that have not expanded Medicaid, but she said the most effective advocacy is going to come from local communities.

“The important conversations now are with local hospitals, the local business community, mayors, certainly, who bear the cost of uncompensated care,” she said.

‘Very much on track’

According to HHS officials, the main topic of discussion in the closed-door meeting was implementation of the health insurance marketplaces scheduled to begin enrolling customers in less than two weeks.

Sebelius said the department is “very much on track to be up and running on the first of October in markets across the country.”

Sebelius is also scheduled to make remarks Saturday in Kansas City, Mo., at a meeting of the Council of State Governments and at community-wide gathering focused on improving mental health services.

Kansas Insurance Commissioner Sandy Praeger attended Friday’s meeting.

She estimated that Kansans interested in purchasing insurance through the new marketplace would likely have about 22 plans to choose from.

Three of the state’s largest insurers — Blue Cross Blue Shield of Kansas, Coventry Health Care of Kansas and Blue Cross Blue Shield of Kansas City — will offer coverage in the new online marketplace.

Praeger held an informational meeting on the new marketplaces in Overland Park on Tuesday, the first of a dozen community presentations on her schedule within the next month.

Incredulous

Two things stuck out from the Overland Park meeting, she said.

First, she said, is the need for the department to reassure senior citizens that the law does not affect their Medicare coverage.

Secondly, she said, people at the meeting were incredulous about the situation in states like Kansas and Missouri that have not expanded Medicaid.

Because of the structure of the premium in the insurance marketplaces, proponents of the Medicaid expansion have noted that some residents will essentially be too poor to qualify for coverage through the exchanges.

Eligibility for premium assistance starts for households at 100 percent of the federal poverty level.

Praeger said that a member of the audience in Overland Park got up and said the commissioner seemed to have misspoken when describing eligibility.

Praeger said her response was, “No, unfortunately I didn’t.”

By Mike Sherry
KHI News Service