MISSION – A Kansas man died in an accident just before 4 a.m. on Friday in Johnson County.

The Kansas Highway Patrol reported a 2005 Chevy Silverado driven by Matthew S. Doan, 33, Shawnee, was on the ramp from Interstate 35 southbound to Interstate 635 north.

While negotiating the curve of the ramp, the truck struck the guardrail.

The driver overcorrected and traveled off the roadway through a grassy ditch.

The truck went airborne, crossing Interstate 635.

Doan was pronounced dead at the scene and transported to First Call.

The KHP reported he was properly restrained at the time of the accident.

By Jim McLean

Former Kansas Gov. Kathleen Sebelius didn’t mince words when asked about the direction of Kansas politics during an event Thursday night at the Dole Institute of Politics. Making one of her first Kansas public appearances since stepping down in June as secretary of the U.S. Department of Health and Human Services, Sebelius called the re-election of Republican Gov. Sam Brownback “a low point” in the state’s political history.

“Every time I think it can’t get any worse, it does,” Sebelius said in an apparent reference to the deepening budget crisis triggered by tax cuts and plummeting revenues.

“So, I hesitate to say ‘how low can you go.’” The Democrat, whose final months at HHS were marred by the problem-plagued rollout of the health reform law, was especially critical of Brownback’s recent decision to rescind an executive order that she issued to protect state employees from discrimination based on sexual orientation or sexual identity. Sebelius said she signed the order in 2007 to “send a strong signal that we wanted a talented and diverse workforce.”

She said she had “no idea” what compelled Brownback to repeal a policy that had been in place for eight years and “seemed to be working well.” “It’s distressing,” she continued. “But I think we need to be clear to people around the United States, this is not Kansas. This is not what the state was founded on.

This is not what we believe in. And this is not an acceptable policy going forward.” In the statement explaining his decision, Brownback said Sebelius’ order inappropriately gave state employees protections not enjoyed by other citizens. Rescinding the order, he said, “ensures that state employees enjoy the same civil rights as all Kansans without creating additional protected classes.”

In addition, Brownback said, decisions to extend additional civil rights protections should be made by the Legislature, not “through unilateral action” by a governor. Sebelius’ comments about Kansas politics came in response to questions from members of an overflow audience that turned out for the first in a series of lectures on women in politics at the institute on the University of Kansas campus in Lawrence.

For most of the evening, the former governor chatted with Bill Lacy, the institute’s director, about her experiences as a woman in politics, her relationship with President Barack Obama and the political and executive challenges she faced during her career. When technical problems with a microphone delayed the start of the conversation, a relaxed Sebelius quipped,

“Kind of the like the website,” a reference to well-publicized troubles with the healthcare.gov website at its launch. Sebelius said the early days of the rollout and the final days of the lobbying effort for the ACA were among her most challenging as secretary. “We had a lot of near-death experiences,” she said of the days leading up to the vote in Congress.

“There were lots of times when it seemed like it was all going down the tubes.” Even when the bill’s prospects seemed bleak, Sebelius said, President Obama resisted calls to pare back the bill and compromise to save political face.

“He kept saying, ‘If there’s a chance for a comprehensive bill, this is the time,’” she recalled. In a brief interview after the program, Sebelius said she believes the ACA will survive because by the time President Obama leaves office, tens of millions of Americans will have come to depend on it for health insurance.

In addition, she said, it will be difficult to reverse the changes the law has made in the health care system. “I think the framework is now kind of in the DNA of the health system in a way that will be very difficult to turn back,” she said.

While making no predictions, Sebelius said, she finds it “hard to believe” that the U.S. Supreme Court will side in an upcoming case with those who contend that Congress intended to make ACA tax credits available to consumers only in states that set up their own marketplaces.

“To have that available only to a certain portion of the population seems ludicrous,” she said. Kansas is one of several states that declined to establish its own online marketplace, forcing consumers to use one set up by the federal government. More than 80 percent of Kansans who selected plans during the current enrollment period have qualified for tax credits that lower the cost of their premiums, according to HHS. Finally, Sebelius said Kansas’ refusal to expand Medicaid has deprived tens of thousands of low-income Kansans of coverage they need.

“Folks who are in states not expanding Medicaid are in terrible trouble,” she said. Brownback and GOP legislative leaders opposed to participating in expansion have said they’re concerned the federal government will not fulfill its obligation to pay 100 percent of expansion costs for three years and no less than 90 percent thereafter. Sebelius said those concerns are unfounded.

“The bill is fully paid for even if all 50 states come in,” she said. State officials who continue to have doubts, she said, could protect themselves by including language in their plans that automatically returns eligibility to pre-expansion levels if federal funding dips below the 90 percent threshold. “Lots of states have said, ‘If the deal changes, we’re out,’” Sebelius said. “And we’ve said from the beginning, ‘That’s just fine.’

Jim McLean is executive editor of KHI News Service in Topeka, a partner in the Heartland Health Monitor team.

TOPEKA, Kan. (AP) — Gay rights supporters are planning a weekend rally at the Kansas Statehouse to protest the end of anti-discrimination protections for gay, lesbian and transgendered workers in much of state government.

The event at noon Saturday is a response to Republican Gov. Sam Brownback’s decision this week to narrow a policy that covers hiring and employment decisions in state agencies controlled directly by the governor.

Brownback rescinded an executive order issued in August 2007 by then-Democratic Gov. Kathleen Sebelius to bar discrimination based on sexual orientation or gender identity.

A state law barring discrimination in housing and private employment doesn’t cover such bias, and Brownback said Sebelius acted unilaterally in her order. Brownback said the Legislature should decide whether to extend such protections to gays and lesbians in state government.

TOPEKA, Kan. (AP) — Kansas lawmakers want to keep money from being transferred away from transportation projects.

The House Transportation Budget Committee voted Thursday to protect $280 million in infrastructure funds that would have been transferred away over the next two fiscal years under the governor’s recommendations. Republican Gov. Sam Brownback recommended transferring a total of $724 million from transportation projects to the state’s main budget over fiscal years 2016 and 2017 to fill projected budget shortfalls.

Democratic Rep. Annie Tietze of Topeka said the move was made because infrastructure works provide jobs and are important to the state’s economy. Tietze said she anticipated the state would state issue bonds to cover the shortfall if the committee’s recommendation were to pass.

The House Appropriations Committee will review the committee’s budget recommendations on Tuesday.

LOLITA C. BALDOR, Associated Press

WASHINGTON (AP) — Defense Department officials say hormone treatment for gender reassignment has been approved for Chelsea Manning, the former intelligence analyst convicted of espionage for sending classified documents to the WikiLeaks website.

The officials say the hormone therapy was approved February 5 by the commandant of the U.S. Disciplinary Barracks at Fort Leavenworth, Kansas, where Manning is serving a 35-year sentence.

The treatment would enable the Army private formerly known as Bradley Manning to make the transition to a woman.

A lawsuit filed in September claimed Manning was at a high risk of suicide unless she received more focused treatment for the sense of being a woman in a man’s body, or vice versa.

The officials were not authorized to discuss the matter publicly, so spoke on condition of anonymity.

TOPEKA, Kan. (AP) — A Kansas birthing center licensed to deliver babies for healthy women with uncomplicated pregnancies has been temporarily shut down and declared a public health risk by the state health department.

The Birth and Women’s Center in Topeka was placed under emergency suspension Feb. 4 after an investigation determined the center had violated several stipulations of its licensing by failing to keep proper records or complying with quality assurance requirements.

The Kansas Department of Health and Environment says it received complaints of an unusually high incidence of medical problems in women and their children who had been delivered there.

A woman who answered the phone at the center referred questions to Dr. Josie Norris, the practitioner who oversees the birth center.

Norris didn’t immediately return a phone call.

NEW YORK (AP) — Facebook is giving more options to decide what happens to users’ accounts after they die.

The world’s biggest online social network said Thursday it will now let users pick someone who can manage their account after they pass away. Previously, the accounts were “memorialized” after death, or locked so that no one could log in.

Beginning in the U.S., Facebook says users can choose a “legacy contact” to post on their page after they die, respond to new friend requests and update their profile picture and cover photo. Users can also have their accounts deleted instead.

Facebook also ensures that the account of a user who died doesn’t show up as a “suggested friend” or in other ways that could upset the person’s loved ones.

By JIM MCLEAN

Kansas hospitals are leading the push for Medicaid expansion.

But they’re not the only providers for which expansion is a critical financial issue. It’s also a priority for the safety net clinics that exist to provide free and reduced-cost care to low-income Kansans.

Two-thirds of the people who rely on the clinics live under the federal poverty line: annual income of $11,670 for an individual and $23,850 for a family of four. Virtually all of them would qualify for KanCare — the state’s privatized Medicaid program — under expansion.

“KanCare expansion is a big issue for us,” says Denise Cyzman, the still relatively new executive director of the Kansas Association for the Medically Underserved.

Cyzman was hired last fall to succeed Cathy Harding, who left to become chief executive of the Wyandotte Health Foundation. Prior to taking the KAMU job, Cyzman was a vice president for the National Kidney Foundation of Michigan.

The KAMU clinics provided care to more than 250,000 people in 2014. However, because many patients couldn’t afford to pay their bills, the clinics ended the year with $44 million in uncompensated care on their books.

Expanding KanCare eligibility to low-income adults would greatly reduce that financial burden, Cyzman says.

“It could generate all the way up to the $44 million,” she says. “But even if we get only a portion of that covered through KanCare, it would be a tremendous economic boost for our clinics.”

The clinics have estimated that expansion would lower their uncompensated costs by at least $25 million, Cyzman says.

Jason Wescoe, chief executive of the Health Partnership Clinic, says KanCare expansion would generate another $1.5 million in revenue for his Olathe-based clinic, which has an annual operating budget of about $5 million.

“Putting $1.5 million into this organization means I hire more doctors, hire more nurses and open more clinics,” Wescoe says. “It seems so simple from where I sit.”

But the politics of the issue is anything but simple.

The connection between Medicaid expansion and President Barack Obama’s Affordable Care Act has created widespread opposition to it among Republican governors. Some have negotiated alternative plans that use federal Medicaid dollars to expand access to private coverage and require recipients to share in the cost of their care. But several of those proposals have run into opposition from GOP legislators.

In Kansas, Gov. Sam Brownback and Republican legislative leaders have so far refused to consider expansion. The Kansas Hospital Association is crafting a proposal that it hopes will appeal to the governor and his fellow conservatives.

The safety net clinics are ready to help lobby for the KHA plan, Cyzman says. But based on preliminary conversations with legislators, she doesn’t expect it to be an easy sell.

“There are more and more (legislators) who say, ‘Well, we’re interested in thinking about it, but we’re really concerned about how the state is going to pay for it,’” Cyzman says. “Until we can figure that out, it’s going to be really challenging to get it through the Legislature.”

The federal government has promised to pay the full cost of a state’s Medicaid expansion through 2016 and at least 90 percent after that. A study commissioned by the Kansas Hospital Association estimated expansion would cost the state an additional $312 million through 2020.

An expansion bill, House Bill 2270, introduced by a committee controlled by moderate Republicans would give the secretary of the Kansas Department of Health and Environment the authority to levy fees on hospitals and other providers to offset the state’s portion of the expansion cost.

It’s not known what financing mechanism, if any, will be included in the hospital association’s bill, which could be introduced as soon as this week.

Fending off budget cuts

The same budget issues that have legislators concerned about the cost of Medicaid expansion are threatening the approximately $8.2 million in funding that safety net clinics receive from the state.

A bill signed Tuesday to plug a $344 million hold in the state’s current budget included a cut of $254,000 for the clinics.

But lawmakers are resisting Brownback’s plan to reduce funding to the clinics by another $378,000 in the next budget cycle.

Members of the House Social Services Budget Committee recently voted to restore the proposed cuts and instead take the money out of the Kansas Department of Health and Environment’s administrative budget.

“They (the clinics) do exceptionally well with the limited funding that they have,” said Rep. Kristey Williams, a Republican from Augusta, as she made the motion to restore the funding.

The bipartisan legislative support the clinics historically have enjoyed is due to the “great work” they do, Cyzman says. But she says she isn’t taking it for granted that support will be enough to spare the clinics as lawmakers struggle to balance the budget in the face of plummeting tax revenues.

“We don’t feel like we’re out of the woods at all,” she says.

Filling the oral health gap

As if Medicaid expansion and the budget crisis weren’t enough, Cyzman stepped into another long-simmering debate when she accepted the KAMU job. The association is a leading member of a coalition pushing for a change in state law to allow for the licensure of a new kind of mid-level dental provider.

Opposition from the Kansas Dental Association has effectively blocked consideration of the mid-level proposal for several years.

Kevin Robertson, KDA executive director, has said repeatedly that the training that dental hygienists would be required to complete to become mid-level practitioners “is simply not adequate” to master the restorative and surgical procedures the proposed changes would allow them to perform.

But Cyzman is among those who maintain that licensing mid-level providers and requiring them to work under the general supervision of dentists is no different from what the state allows doctor-supervised advanced practice registered nurses to do: diagnose and treat patients.

“Nurse practitioners have freed up doctors,” she says. “We can do the same for dentists. We can increase access to care and give our dentists the opportunity to provide the higher-level, complex care they are trained to do.”

Several safety net clinics offer dental services. But recruiting dentists is difficult. Licensing mid-level practitioners would expand the recruiting pool, Cyzman says, and help to alleviate a documented shortage of dental providers in 95 of the state’s 105 counties.

Editor’s note: The coalition advocating for licensure of mid-level dental providers is supported by the Kansas Health Foundation, which also provides most of the funding for the Kansas Health Institute, the parent organization of the editorially independent KHI News Service.

Jim McLean is executive editor of KHI News Service in Topeka, a partner in the Heartland Health Monitor team.