SEK hit hard by Medicaid limits

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October 7, 2013 - 12:00 AM

It was hard news to deliver for such an avid advocate of the new health care law.
Southeast Kansas, particularly, will be hit hard by the state’s decision to not expand its Medicaid program as provided by the federal government.
“That decision, alone, will keep thousands of your citizens from enjoying health insurance for perhaps the first time in their lives,” said Sheldon Weisgrau.
Weisgrau addressed an audience of about 60 on Thursday night at the Townhouse West assembly room. He is touring the state informing audiences about the ins and outs of the Affordable Care Act on behalf of six major health care organizations, including the REACH Healthcare Foundation and the Health Care Foundation of Greater Kansas City, both of which have a presence in Allen County through their support of the Rural Health Institute, Thrive Allen County, SAFE BASE after-school program, Hope Unlimited, and others.
The idea under the new Affordable Care Act was to make health insurance available to everyone. For those who lived below the federal poverty line — $11,500 for an individual and $23,550 for a family of four — they were to receive health insurance by being enrolled in a state’s Medicaid program, which is primarily for the poor and disabled.
The government figured if a state expanded its Medicaid guidelines to accept people whose incomes came to within 138 percent of the federal poverty line (FPL), or $15,856 for an individual and $28,000 for a family of four — then that would cover the U.S. population.
For those living at the FPL and up to 400 percent above, the Affordable Care Act provides tax credits according to one’s age, income and family size, for U.S. citizens. Illegal immigrants are not covered by the ACA.
Two problems arose for Kansas.
First, its Medicaid program is only for the poorest of the poor.
A single mother of two working a part-time job can earn no more than $6,000 a year to receive Medicaid benefits. The state’s Medicaid program also is not based on income alone. Recipients have to be either disabled, single mothers, or elderly. An unmarried male is not able to receive Medicaid benefits.
Secondly, Gov. Sam Brownback pushed the decision to expand the state’s Medicaid rolls onto state legislators, who took no action.
The inaction and low Medicaid standards create a significant gap in coverage for Kansans. Southeast Kansas has a disproportionate amount of low-income residents who will fall into the insurance gap because they are too poor to qualify for the ACA tax credits for those at above the federal poverty level, but too rich to qualify for the state’s Medicaid program, which includes health insurance.

THE LACK of health insurance will play havoc on the health care system, specifically hospitals, Weisgrau said.
Under the previous system, the federal government gave hospitals a stipend to help cover the cost of treating people who could not afford their hospital bills. By law, a hospital’s emergency room cannot turn away those seeking care, no matter their abilities to pay.
With the Affordable Care Act, the federal government redirected that stipend to hospitals to the expanded Medicaid program, where it has agreed to pay 100 percent of costs incurred by expanding its client base.
Needless to say, for the states that have said no to the expansion, hospitals will suffer a double whammy. They still must treat the uninsured poor, but now without any federal aid.
A likely consequence will be an increase in property taxes to help hospitals bear the uncompensated costs, Weisgrau said.
“The money is going to have to come from somewhere,” he said.
Had Kansas accepted federal funds to expand its Medicaid rolls, hospitals could rest easy.
The formula has the federal government paying 100 percent of the additional costs of expanding its Medicaid rolls. After several years, states are to assume 10 percent of those costs.
The economic stimulus from the federal government to pay for the expanded program offsets the cost to Kansas for expanding its Medicaid program many times over, Weisgrau said.

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