House Republicans injected their four-part KanCare health care overview into the thinking of fellow lawmakers Monday in Topeka.

The plan is short on numbers and makes broad suggestions about health care, with promises of details next week.

“As far as in-depth details, I don’t see a lot of them there,” Rep. Cindy Neighbor, D-Shawnee, said.

Rep. Jeff Colyer, Overland Park, chairs the Kansas House Republican Task Force on Health Care and defended the group’s overview.

“We’re finally talking about the No. 1 issue on people’s minds,” Colyer said.

KanCare offers broad thinking about ways to deal with specific health coverage needs, Colyer said. Running a close second to getting more people insured might be how much the plan would cost and who would pay.

“In terms of overall costs,” Colyer said, “that hasn’t been evaluated yet.”

Neighbor said she looks forward to learning more next week.

“There’s a lot of work that’s going to have to be done in the Medicaid arena for this to work and I haven’t seen any real information on that yet,” she said.

Colyer said the task force decided against fattening the bureaucracy and mandating insurance coverage.

“We don’t want to make government bigger in this process, we want government to be smaller,” he said. “The whole goal is to move people, from being uninsured and on Medicaid, into the commercial insurance sector.”

The state should spend fewer tax dollars for insurance coverage, Colyer said.

“Most of the costs that we are talking about are simply reprogramming what is already in the budget,” he said, “and making it more efficient.”

The overview calls for making commercial insurance more affordable, moving Medicaid and uninsured people into the private market, decreasing reliance on Medicaid and strengthening charity care providers.

Colyer said Kansas must deal with escalating Medicaid costs now or risk breaking the budget.

“If we do not do something, within a decade we will be paying more for Medicaid than we do for our entire school budget,” he said.

The plan is a good first step, Rep. Kay Wolf, a moderate Prairie Village Republican, said.

“We’re all very concerned about the rising cost of health care and the uninsured,” Wolf said. “We obviously will be doing a lot more study on this because we just rolled it out. …

“We will definitely not just jump into something and then wish we hadn’t.”

AFFORDABLE INSURANCE

Rep. Pat Colloton, Leawood, a moderate Republican, said the uninsured would need financial support to buy commercial insurance.

“The ability for the low-wage earner to afford the kind of prices that are attached to (the plan) is just totally unrealistic,” Colloton said.

In theory, the state would expect to garner a pool of participants large enough to coax insurers to offer low-rate coverage, Colloton said, but the theory may not stand up to the practice. A similar “connector” plan in Massachusetts suggests individuals pay $380 per month with a $2,000 deductible, according to the Boston Globe.

“I don’t think the connector’s going to work here,” she said.

The committee issued a statement stating, “Our model is different from a Massachusetts Connector,” but makes no mention of how much buying into private insurance would cost. Colyer said details would come later.

“Most of the issues here are going to be evolutionary,” he said. “This year we are setting the foundations of trying to make health insurance, commercial insurance more affordable.”

Tax credits will help get the public to buy private insurance, Colyer said. Larger businesses offer employees a flexible health spending account that sets aside funds before taxes. Colyer said the committee would like to help businesses with fewer than 20 employees offer a flex plan, which would mean less state spending on health care for the uninsured.

“We’re going to end up saving millions of dollars just by getting that program up and going,” Colyer said.

The tax break plan offers a meaningful benefit, Colloton said.

“It’s a small thing, but it could be worth as much as a 15 percent benefit on the health care costs,” she said.

The Democrat, Neighbor, said her party could support the idea.

“That’s going to be the employer’s choice and the employees can do that if they choose,” she said.

Although employees at smaller businesses could benefit, how many could afford to set aside money for a pre-tax health plan is not clear, Neighbor said.

“A lot of lower-income people n this is going to be very hard from them to set aside,” she said.

Although other parts of the overview may take months or years to develop, adopting the flex plan for small businesses could come quickly, Colyer said.

“I would expect something like that to move this year,” he said.

PRIVATE INSURANCE

An insured person who undergoes a layoff may lose coverage, but the Republican plan suggests insurance could be maintained through vouchers and tax credits.

Colyer said the committee has not determined how much vouchers and tax credits would cost taxpayers.

“The exact amounts on this are unclear right now,” he said.

Numbers will coalesce as House members detail the overall health plan, he said.

“We’re talking about 16 percent of the state economy,” Colyer said. “This is not something where you go and fix it with one simple bill right now. This is something we have to approach over the next two or three years and there are going to be a number of moving parts. We need to have that flexibility.”

One method of helping individuals buy into insurance offered under the GOP plan is to provide seed money to encourage association plans that target small communities, ethnic organizations and ethnic groups. Neighbor said Republicans did not let the House Democrats get a bill that offered similar provisions, 2328, out of committee.

“That was exactly what we had presented earlier this year,” Neighbor said.

MEDICAID REFORM

“The Medicaid stuff, that’s where the money is. Kansas spends $2 billion on Medicaid right now,” Colyer said. “How we spend money is absolutely critical, because we need to give people choices.”

Colyer said the public needs a better choice than to make costly emergency room visits just to see doctors.

“Only about 25 percent of the doctors in the community even accept Medicaid,” Colyer said. “My Medicaid patients are hugely upset. They don’t have choices, so what do they do? They go to the emergency room, because they don’t have a significant co-pay; they can actually see a doctor.”

More doctors would see Medicaid patients if the bureaucracy could be streamlined to reduce costly paperwork, he said.

“That cuts some of the costs to the medical community,” Colyer said.

The bureaucracy in part exists to police Medicaid cheats. Colyer said cheating might be monitored differently in a streamlined system.

“In the Medicaid program, we don’t have an inspector general, we do not have a waiver where we can go recover waste, fraud and abuse dollars,” he said. “That’s one of the very first things we’ve got to do.”

CHARITY CARE

Charity care could be improved by strengthening free care clinics, according to the task force.

“That’s a place where we’ll end up spending some more money,” Colyer said. “Hopefully, that will come out of the savings that we get out of other parts of the budget.”

The state now supports 24 “safety net clinics,” he said. A way to improve service and lower costs would be to let them use prescription drugs that might otherwise be thrown out.

Colyer, a physician, said hospitals must throw out good, unused, untouched drugs under present law. Colyer said safety net clinic patients could use those drugs.

“The safety clinics have come to us and said, ‘Can we have that?’ And the hospitals have said, ‘We’d like to give it to them.’ We can do lots of things like that to strengthen those clinics,” he said.

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