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 Brownbackâ€™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 Brownbackâ€™s â€œKanCare,â€ 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 â€” United Healthcare, Sunflower State Health Plan (owned by Centene Corporation), and AmeriGroup. Amerigroup and Centene each gave $2,000, Kansasâ€™ maximum allowed contribution, to Brownbackâ€™s re-election campaign. …
… Brownbackâ€™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 â€“ 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 â€œgot really pissed offâ€ at Brownbackâ€™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.
â€œHe said, â€˜Just go over to your neighborâ€™s house and theyâ€™ll put it back on for you,â€™â€ Bullers said. â€œI mean, hereâ€™s the governor of the state of Kansas, telling me that, you know, your life isnâ€™t worth it, that itâ€™s okay if you die and leave two small children without a father.â€
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.