More on the Kansas Experiment

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elections, Republican Party

Y’know, maybe we all should have been paying more attention to Kansas. I wasn’t fully aware that Gov. Brownback had not only refused to expand Medicaid under the ACA; he actually privatized it.

Let’s start with what looks like a re-written press release from 2011.

Gov. Sam Brownback and his administration’s top social service officials today unveiled their proposal for reforming the state’s Medicaid program.

In a nutshell, it would expand managed care to all currently on Medicaid, including nursing home residents, the disabled and the mentally ill. It also would prompt reshuffling of departments at four state agencies. Officials said the plan would save the state $12.5 million in the coming fiscal year and a total of about $367 million over the next five years.

The plan was to turn the Kansas Medicaid program over to private companies, who as we know always do everything better for less money, right? Anyway, the retooled Medicaid program was named KanCare, and lots of stuff got shuffled around from this department to that one, which obviously was another cost saving. So how did it work out? This is now:

Since Brownback’s inauguration, 1,414 Kansans with disabilities have been forced off of the Medicaid physical disability (PD) waiver. In January of 2013, Brownback became the first governor to fully privatize Medicaid services, claiming he would save the state $1 billion in 5 years without having to cut services, eligibility, or provider payments. Now, under Brownback’s “KanCare,” PD waiver cases are handled by for-profit, out-of-state, Fortune 500, publicly-traded managed care services. Kansas has contracts with three managed care profiteers — United Healthcare, Sunflower State Health Plan (owned by Centene Corporation), and AmeriGroup. Amerigroup and Centene each gave $2,000, Kansas’ maximum allowed contribution, to Brownback’s re-election campaign. …

… Brownback’s claims of savings without risking patient eligibility is mere sleight of hand when taking a closer look at the numbers. When Kansas experienced a $217 million revenue shortfall in April of 2014, Brownback actually broke a promise made to the federal government as to how many people with disabilities would be served. When applying to launch the KanCare program, the Brownback administration originally promised the U.S. Department of Health and Human Services it would accommodate 7,874 people on the PD waiver, according to numbers from the Kansas Department for Aging and Disability Services. After the first revenue shortfall, Brownback changed that number to 5900 – nearly a 25 percent cut in services amounting to $26 million.

Note that some of the services being cut could mean life or death for some people.

Death panels? Do I hear death panels?

One of the people whose services were cut complained.

Bullers, a former 15-year veteran reporter for the Kansas City Star and father of two, fought from the time of his managed care review in January of 2013 all the way to New Years Eve of 2013 for his full-time care to be restored. He used his status as a public figure in Kansas to organize awareness campaigns in both traditional and social media, and even arranged a meeting with Gov. Brownback. Bullers said he “got really pissed off” at Brownback’s response to a question he asked about not having a home care provider available if his ventilator came loose, stopping air from getting into his lungs.

“He said, ‘Just go over to your neighbor’s house and they’ll put it back on for you,’” Bullers said. “I mean, here’s the governor of the state of Kansas, telling me that, you know, your life isn’t worth it, that it’s okay if you die and leave two small children without a father.”

Death panels!

About a year ago The Pitch published a long expose on the screwup that is KanCare. The points it makes, in brief — Privatizing a service doesn’t make the cost go away; it just shift the cost around. And then in addition the private companies take profits and administrative costs, so less money goes to the patient. How in the world this scheme was going to save the state money seems to have been magical thinking. Ultimately the only way to make the program less expensive is just to pay for less stuff.

And I understand there have been issues with the private companies failing to disclose information to the state that has frustrated people responsible for eliminating fraud. See also KanCare companies lost money in first year.

And, of course, Brownback turned down million of federal dollars by refusing to expand Medicaid.

The wonder to me is that while Brownback has been trailing his Democratic opponent in polls, it hasn’t been by a huge amount. Apparently a substantial percentage of Kansas voters intend to return this loser to office.

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21 Comments

21 Comments

  1. Dukkha Earl  •  Oct 27, 2014 @8:46 pm
  2. buddhacrone  •  Oct 27, 2014 @9:39 pm

    Missouri doesn’t take federal money for Medicaid or Food Stamps. When that charming decision was made, many of us found our food stamps cut by 75% or so. From getting $77/mo to $16/mo., that really hurts when you are old and disabled. Getting on Medicaid and/or staying on Medicaid is just as iffy. When you are too poor to move to a state that is more sensible, it’s a problem, let me tell you.

  3. c u n d gulag  •  Oct 28, 2014 @7:39 am

    Poor, poor, Sam Brownback…

    If he loses his reelection, it will be because he will have failed Conservatism.
    Since Conservatism can’t fail, it’s only the people elected to try to administer it, who fail – and it’ll be his fault:
    Brownback, wasn’t conservative enough!

    Conservatism is like a religion.
    You have to have faith in it.
    Because, no matter how much evidence there is that it’s a terribly flawed and failed “philosophy,” and doesn’t work and hasn’t worked, you must keep the faith.

    These insane people keep doing the same thing, over and over again, and expect Conservatism and the “Free Markets” to do their magic the next time.
    The next elected conservative, will get it right!
    Until he/she fails Conservatism – AGAIN!

    Never mind drowning government in a bathtub – the toilet-bowl that is today’s America, keeps swirling further and deeper to the right.
    Soon, on our path – unless we change – we’ll be in the sewer.
    We’re almost there already…

  4. goatherd  •  Oct 28, 2014 @8:32 am

    I’ve been out of the business a long time, but I am sure it would be easy to collect a huge number of anecdotes. For example:

    Back in the 80s, I ran a program that did a lot of work for Vocational Rehabilitation clients. We had a fee for service schedule that allowed us to charge $11 per hour of service delivered and $7 dollars per hour per person attending group training with a limit of three people, so additional attendees got free service. We were a non-profit, so if we could keep our heads above water, we didn’t mind the extra work.

    When the program was expanded, we were encouraged by the scale of the program and the prevailing trend toward toward private sector involvement to engage HealthSouth for the provision of therapy. We had provided what was called “practical therapy” at the time. This would be a series of exercises and skills prescribed by a Physical or Occupational Therapist and carried out by experienced paraprofessionals. The fee schedule was as I described above. When the miracle of the private sector entered the scene, the activities prescribed were monitored by a “Tech” who was paid about $10 an hour. (not meaning to suggest that any general correlation with their skills or dedication.)

    Part of our program served agricultural workers who had been severely injured here in the US. None of them spoke English. My Spanish was pretty good then, so asked the Tech if she spoke Spanish. She didn’t, not a word, but she declined my offer to translate.

    When I interviewed our clients about the services they received, they said that the Tech would show them an exercise by demonstration, for example curling a one pound weight with the right arm. Fifteen or twenty minutes later, she would return to advise them to switch to the left arm. After that, the therapy was over. The language barrier prevented them from asking for activities to do at home or from getting other information. HealthSouth was able to charge $125 per hour, per person, or $750 total per session, for the services to the group, three sessions a week. We would have been paid $21 and we would have had a Spanish speaking provider there. But, faith in the private sector meant that a large corporation’s name on the billing invoice meant “quality.”

    And:

    When a few of my friends were working for private rehabilitation companies as therapists, the bulling criterion changed from “fee for service” to DRG or “diagnosis related grade.” The difference was that DRG provided a fixed, lump sum according to disability. So, if a patient had had a stroke, for example, the provider would receive the same amount as for all the other post stroke patients, in most cases regardless of the severity. Under fee for service, therapists were encouraged to prescribe therapy as often as possible, whereas under DRG the provider was out to cut costs by minimizing services. So, literally, one day under fee for service, a patient needed therapy every day, sometimes twice a day, and the next day under DRG, that same patient suddenly only needed one session a week. The therapists wound up being collateral damage, since far fewer of them were needed after the market solution had worked its magic.

    Capitalism may do some things well, other things, not so much. Healthcare is definitely in the latter category. People let go of their beliefs reluctantly. So we see different implications in the same anecdote. It takes a cataclysmic, unequivocal disaster to separate us from a comforting ideology or belief, and sadly, real world “death panels” seem less motivating than the ones that inhabit only the mind.

    I am sorry to be so long winded, but, this subject presses my buttons.

  5. c u n d gulag  •  Oct 28, 2014 @10:50 am

    goatherd,
    I feel your pain, brother!

    At least a couple of generations learned from the crash in October of ’29 – 85 years ago.
    We had a well-functioning middle class economy after WWII.
    All due to people remembering the hard times, and the Keynesian solutions that FDR applied.
    Liberalism helped this nation become the greatest in the history of the world.
    Greed and its ally and bosom-buddy, Conservatism, have us on the flushing point of being a Banana Republic – thanks to banana’s Republicans.
    And the idiots and bigots in our pool of voters who allow themselves to be divided, so they can more easily be conquered.
    Kansans are drowning in Conservatism.
    Wanna bet they’ll decline the lifesaver that the Democrats could throw them?

  6. c u n d gulag  •  Oct 28, 2014 @10:50 am

    goatherd,
    I feel your pain, brother!

    At least a couple of generations learned from the crash in October of ’29 – 85 years ago.
    We had a well-functioning middle class economy after WWII.
    All due to people remembering the hard times, and the Keynesian solutions that FDR applied.
    Liberalism helped this nation become the greatest in the history of the world.
    Greed and its ally and bosom-buddy, Conservatism, have us on the flushing point of being a Banana Republic – thanks to banana’s Republicans.
    And the idiots and bigots in our pool of voters who allow themselves to be divided, so they can more easily be conquered.
    Kansans are drowning in Conservatism.
    Wanna bet they’ll decline the lifesaver that the Democrats could throw them?

  7. Swami  •  Oct 28, 2014 @1:42 pm

    http://www.huffingtonpost.com/robert-reich/empathy-deficit-disorder_b_6060194.html

    “In fact, you’d think empathy would be the minimum qualification to hold public office in a democracy.”
    Well, that’s not a bad idea! Kinda reminds me of Clarence Thomas..I’m surprised he hasn’t changed his name to Osborne White. It’s like.. I got mine so screw the rest of you low lives with your petty Voting Rights Act complaints and demands for affirmative action.

  8. Swami  •  Oct 28, 2014 @1:46 pm

    I guess it’s fair to say that Rush Limppud suffers from both ED and EDD?

  9. LongHairedWeirdo  •  Oct 28, 2014 @2:12 pm

    The idea behind privatization helping is something like this.

    Let’s say you’re doing governmental work. You have no profit motive. So if you have four workers, but really only need three, you just don’t have the heart to fire someone, well, no biggie… you’re not losing anything! And if you’re buying from the guy who buys you the best drinks and lap dances, rather than the best supplier, well, no biggie – you’re not losing anything!

    Ah, but private enterprise – they’ll lay off that unnecessary fourth worker, they’ll buy the best products that the best pri(AH-CHOO – no, I wasn’t about to burst into giggles, I just had to sneeze).

    Where was I? Right, privatization will find efficiencies that a bureaucrat won’t find. That’s the theory.

    Is it true? It might be, but making the incentives work right can be horrible.

    It’s one thing if it’s making sure that DOT has enough paint to make stripes on the road. But what if it was evaluating people for SSDI? Well, the incentives will probably be on the side of disapprovals – and that can create an incentive for the wrong behavior, since the goal is to give people benefits to which they are entitled.

  10. Mike G  •  Oct 28, 2014 @4:42 pm

    Being cruel to people on public assistance is a net positive with the Republican base.

  11. Swami  •  Oct 28, 2014 @5:51 pm

    Here’s something I’ve been noticing but I’m not exactly sure of what I’m seeing. Do you remember Herman Cain’s 9-9-9 plan? Well, I just read recently that Florida’s Governor Rick Scott has some sort of a miracle plan in effect that is described as a 14-14-14 plan. I don’t know what it entails but I see a similarity to Herman’s triple digit sequencing method and I sense some sort of conservative coding designed to diminish government services while appearing reasonable and prudent.
    Our town recently devised a new plan for garbage pick-up and they proudly billed it as a 1-1-1 plan. The idea is garbage pick-up will be reduced to 1 day a week from the current 2, and recycling and yard trash will remain at the current 1 day a week pick schedule. It sounds all well and good considering there will be a significant saving in costs to the taxpayer.
    But, those savings will not be passed along in the form of reduced rates to the taxpayer. They will be funneled back into the city’s coffers to be spent in some other fashion. It’s sort of like a sleight of hand where the taxpayer thinks they’re saving money but in reality it’s just a redistribution of funds that cut out jobs for some and increases the work load for others while providing no relief for the taxpayer.
    It sounds like a model of efficiency until you look closer and analyze what exactly is being done.
    The taxpayer is getting less for more. Even though the rate stays the same and it might not be apparent that the taxpayer is paying more, but if you reduce the service without reducing the rate, the rate, while unnoticed, will increase in relation to the diminished service.
    Win win!

  12. Doug  •  Oct 28, 2014 @9:35 pm

    I think a lot of liberals don’t give Brownbeck enough credit for the plan – it’s doing exactly what it was intended to do. If you cut essential (as in, life or death essential) medical services – so they aren’t available to you in Kansas, but they are available in say, Missouri, you are likely to relocate when the option is a box or urn. You might have to uproot the family, take a loss on the house.. whatever. You’ll go.

    Bu definition, the state that will offer services is more liberal than Kansas. The financial burden has been relocated from a red state to a blue state. This is an objective of the plan. Kansas wants these people who will be a long-term financial drain to GO AWAY. In the process, they change the balance sheet of Kansas to something better, but there’s an added bonus. These non-producing parasites who got sick are now a drag on a liberal state whose financial status got incrementally worse. However, multiply it by thousands of people in all the red states and force them on the blue states and all is good in Gault’s Gulch.

    This model only works if the states have the money and control. If a program is federally funded and administered in all states, dumping the poor and sick on the doorstep of liberal states won’t change the balance sheet. If you ‘get’ that concept, you get why the argument to transfer federal funds in block grants to the states with no standards or controls is a sucker play.

  13. Bonnie  •  Oct 29, 2014 @1:15 am

    As a former government employee, I never worked in any office that could be considered overstaffed. The difference between privatization and government is that the employees in the company that takes over the government function has no loyalty to the government as an employer. I would say that most of us believe that when we take someone’s money for eight hours of work, we feel we need to give that employer eight hours of work. The government loses that commitment from employees who are working for a contractor. Their commitment is to the contractor not the government.

  14. goatherd  •  Oct 29, 2014 @8:28 am

    I never worked directly for the government, as Bonnie did. But, working for non-profits which received government grants, my co-workers and I were often placed in the same category, by the growing, outraged, small government types. Due to the relentless campaign to discredit anything that could be painted “liberal” or government, there seemed to be an endless supply of rightwing cranks who were convinced that we were just watching the clock and collecting our checks. Nothing could be further from the truth.

    It was true that most of my co-workers were politically liberal. Along with that came the the ideas that “what we can do, we should do” and that putting your shoulder and collectively, our shoulders, to the wheel was the best attempt at solving a problem. Sometimes we did okay, sometimes we didn’t. Most of us traded the chance to make a bit more money for the chance to do something that we thought could make a difference. Whether we made things better or not is evidently still a subject of contention.

    To conservative, small government types and other “moral superiors,” we were just wild eyed hippie remnants, hare brained naifs and liberal elitist hypocrites. Okay, fair enough. It would have been a waste of energy to try to convince them otherwise.

    I know next to nothing about Zen, but one of the lessons that seems the most true, is that if you set about to do something “good” or to help someone, you have to give up any notion that your efforts will be recognized. If you do your job well, you may shift circumstances towards the better, but no one will notice, it will be as if it had just occurred by chance. At any rate, you do the best you can to leave things better than they were, the need for recognition, gratitude, and confirmation of your “goodness” is just a distraction and a waste of time and energy that would be best turned towards more work.

    To go a little further off topic, Has anyone read “A Tale for the Time Being” by Ruth Oseki? I am about half the way through and it’s hard to put down. Ruth Oseki is a film maker, novelist and Zen priest, according to her blurb. For those of us among the clueless, it seems to weave basic Zen concepts into a more accessible form.

    Also, LongHairedWierdo, you mentioned that your were a Shaman. Have you ever read any John Michael Greer, AKA the Archdruid? He’s really well worth reading.

    As always my apologies for the excessive monkey chatter.

  15. maha  •  Oct 29, 2014 @10:11 am

    goatherd — I not only read “A Tale for the Time Being,” I also got to meet Ruth Oseki. She came to speak at the Zen center last year and she was thoroughly delightful.

  16. paradoctor  •  Oct 29, 2014 @12:35 pm

    Death panels?
    I second the motion.

  17. paradoctor  •  Oct 29, 2014 @12:42 pm

    cund: when the Berlin Wall fell, then so did the American middle class; for there was no longer a Brand X that the plutocrats had to be better than.

  18. c u n d gulag  •  Oct 29, 2014 @1:06 pm

    paradoctor,
    Yeah.
    I’ve written about that theme for years.

  19. goatherd  •  Oct 30, 2014 @8:53 am

    “I not only read “A Tale for the Time Being,” I also got to meet Ruth Oseki. She came to speak at the Zen center last year and she was thoroughly delightful.”

    Boy, there sure are advantages to living in a civilized place. We just discovered her by accident. I’ll have to check out her other work and hope that some of her insights “seep in.”

    I love the way she uses the language, among many other things. But, I think she is doing a much better job at teaching about Zen, than say someone like Alan Watts. She makes some of the concepts come alive, so that those of us who are less spiritually evolved and ungifted students can at least get a taste of it, or so it seems.

    On top of that, of course, Alan Watts, was not exactly an admirable person in the way he related to women, if what I’ve heard is true. It’s hard to imagine Ruth Oseki being anything but delightful, but I am glad that you confirmed that.

  20. paradoctor  •  Oct 30, 2014 @6:53 pm

    Cund: Once upon a time some yeshiva students in Czarist Russia asked the rabbi, “Which is better, global socialism or socialism in one country?” The sage replied, “It is better to have socialism in one country, and to live in another country.”
    Maybe we can update that to, “It is better to have conservatism in one state, and to live in another state.”

  21. LongHairedWeirdo  •  Nov 12, 2014 @1:57 pm

    Goatherd:
    No, I hadn’t read much by him yet, but omg, if my beard grew that long, I’d wonder if my dad had a few dalliances out his way. I’ll have to check him out.



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