By John Celock
The Republican-controlled Kansas House of Representatives gave preliminary approval Friday to a plan to move the state out of Obamacare and into a health care compact of the states.
The House action advances a bill that could move the state out of the Affordable Care Act and into a health care compact with at least eight other states, pending congressional approval. Advocates say that the compact, which would allow Kansas to decide how to spend a federal health care block grant, would give the state more control over its destiny, while opponents say it could jeopardize the state’s Medicare program.
“Kansas would regain control of our health care needs while receive a proportional share of health care dollars,” state Rep. Brett Hildabrand (R-Shawnee), the bill’s sponsor said during the debate. “With the health care compact in place the Legislature of Kansas can shield our seniors from the impact of the Affordable Care Act.”
Hildabrand said that his legislation would allow for Kansas to join the health care compact and decide health care decisions in-house. Among these he said would be to not raid Medicare funds to pay for Medicaid and decide on health care mandates for residents, not the federal government. Under the terms of the compact, Kansas and the other states would be able to leave Obamacare if Congress approves the agreement, President Barack Obama’s signature would not be required. Congressional approval is considered unlikely while Democrats control the U.S. Senate.
Opponents of the compact legislation argued that the shift would not protect Medicare, noting that all health care funds from the federal government would be sent to Kansas as a block grant and lawmakers would then determine spending.
State Rep. Louis Ruiz (D-Kansas City) told lawmakers that Medicare needs to be protected and cited concerns raised by state Insurance Commissioner Sandy Praeger (R), a moderate Republican who has backed the ACA, that the block grant funds could be shifted from health care to other state needs. Hildabrand shot back at this assumption saying that his bill would require the funds be spent on health care based on federal rules for those dollars, unless the states make a change.
Hildabrand also questioned Praeger’s interpretation of the legislation.
“That expresses that she doesn’t understand the compact,” Hildabrand said. “It says that those dollars have to be used on health care.”
Ruiz said that too many concerns have been expressed about the health care compact for Kansas to move forward on it. He noted that Native American tribes oppose the measure. He also reminded his colleagues of the importance of protecting federal investment in Medicare.
“A lot of us are not spring chickens. We are going to be using Medicare,” Ruiz said. “Do we want to jeopardize our investments? I don’t.”
Rep. Brandon Whipple (D-Wichita) questioned Hildabrand if under his bill the state could end up running the Medicare program. Hildabrand said only if the Legislature approved such a plan.
An amendment offered by Rep. Jim Ward (D-Wichita) to exclude Medicare from the compact was defeated. Ward had said that he has been getting calls from residents who have described Hildabrand’s bill as “scary.”
Hildabrand supporters described the bill as a way to protect Kansans and allow the state control. The legislation follows a series of debates over Obamacare in the state, with the issue taking centerpiece in GOP attacks of Democrats and moderate Republicans during the 2012 state legislative elections.
Rep. Allan Rothlisberg (R-Grandview Plaza) told his colleagues that the federal government should not be trusted.
“This will allow us to run our own programs more effectively,” Rothlisberg said “There are very few federal programs that are run effectively and health care is not one of them. Medicare and Medicaid have a high fraud rate.”
Rep. Barbara Bollier (R-Mission Hills) expressed concern over the lack of input from health care organizations on the legislation. She noted that state Hospital Association, along with groups representing doctors and nurses did not testify at a committee hearing on the bill.
Hildabrand said the groups were neutral on the legislation. Bollier told her colleagues it was a telling sign that they skipped the hearing.
“My concern is that if we look and we say ‘gosh there are problems in Medicare and Medicaid and the federal government running whatever it is we have in our health care.’ If this was the answer I’d guarantee all those organizations would be begging us to do that,” Bollier said. “They have been silent. They are not interested. Maybe they think this is a joke. Most of people in Kansas are employed as health care providers and those people would be speaking up. I am listening to their voice. I am listening to the voices of those contacting me. No one is contacting me. As a physician, a retired practicing physician and married to a physician, I can say they are not interested in this. They are not ready for our state to run all of this. We don’t have a plan set forward.”
Hildabrand though offered a different reason for why the health groups did not appear.
“I would say if they had a problem with this bill they would have been here,” he said.
The legislation faces a final vote on Monday and then moves to the Republican-controlled state Senate.