“This legislation would include but is not limited to Medicare, Medicaid, the children’s health insurance program, rural hospitals, hospice and federally qualified health centers," Praeger said. "The funding would be received in a block grant to the state, and the state Legislature would decide how to spend those health care dollars.” The eight states passing bills in support of the health care compact are Texas, Oklahoma, Missouri, Alabama, Georgia, Indiana, South Carolina and Utah. The concept is modeled on legislation promoted by the American Legislative Exchange Council, an organization comprised of conservative legislators and business owners. Rep. Brett Hildabrand, R-Shawnee, introduced the bill challenged by Praeger. He discounted the notion House Bill 2553 was more of an ideological statement than a meaningful piece of legislation.

And there is the answer. ALEC. Once again, ALEC at hand. This form of legislation provides state government with unbelievable control over your medical choices in a way that hasn't existed before. Beyond yielding a 'compact' (which is pointless at this level as an insurance negotiating method, though I'll cover that in another diary) what this really does is put a gap in the way, to allow states to enforce their own brand of healthcare.

But what's better is the evolution of this bill. As noted above, the bill is actually a plain text reading of ALEC... but six days ago:

http://www.kansascity.com/...



Hildabrand, who conceived the plan with Secretary of State Kris Kobach and Sen. Mary Pilcher-Cook, said his bill is meant to be a practical solution rather than ideological statement. “I truly do believe that it’s a practical bill. I think as time goes on, as we see some of the exemptions that have been given to Obamacare, as we see those removed, I think more and more people will be looking to get out of Obamacare any way possible,” he said.

Kelly Arnold, chairman of the Kansas Republican Party, said in a phone call Monday that furor over the Affordable Care Act would help sway younger voters who might be upset with the party’s stance on social issues to vote for Republicans in November. The Affordable Care Act has been a frequent target at the Capitol this session. Pilcher-Cook, R-Shawnee, chair of the Public Health and Welfare Committee, held hearings in January about the act’s impact on Kansas businesses. Asked about his hesitation to expand Medicaid as called for in the Affordable Care Act, Gov. Sam Brownback issued a statement Monday that criticized the Obama administration’s rollout of the act. “Obamacare is fundamentally flawed and the disastrous rollout is just another indicator of the problems we will continue to see,” Brownback said in an e-mail. “My first priority is to extend KanCare to those who need it most: Kansans with disabilities on waiting lists for services.”

So, was this the brainchild of Kobach (who is a drafter for ALEC) and Cook/Hildabrand, or was this pretty much all ALEC? You decide. But it seems as though the idea presented days ago that this was the brainchild of those in the Kansas legislature has quickly disappeared as a branding method. I guess someone thought it would make them look smart, but now they might prefer the distance.That's right. Republicans know that you're upset with attempts at civil rights and other issues, but it thinks that young adults hate ObamaCare more, and when they go to the polls, it's the only issue they will vote on. As a result, Kansas intends to extend KanCare (their privatized medicaid alternative) to SSI Disability Medicaid recipients this year.

How has that gone over?



One thing that hasn’t changed is that parents of children with disabilities have remained ferocious advocates for their loved ones. While my mom along with many other parents, solicited school districts to include classes for special needs children in public schools, parents now advocate for keeping case managers, obtaining and maintaining quality services, or acquire opportunities for increased independence. With the intense advocacy for the exclusion of services in KanCare, still fresh in my mind, I thought I’d share some information from a few parents who are on “KanCare Watch”. Some parents/guardians in Sedgwick County are hoping to initiate a statewide communication tool now that KanCare has been extended to long-term I/DD services. Their goal is to create a website where parents/guardians can record their experiences with KanCare. These parents are seeking the support of I/DD parents/guardians and other advocates in two ways: 1) Volunteers who would be willing to serve on a statewide steering committee for the website. They would like 6-8 parents representing all geographic areas of the state. 2) Donors who could help raise the estimated one-time cost of $1,500 for design and hosting of the website for one year. They have an I/DD parent in Wichita in the web design business who is willing to donate some in-kind services to this project. Now, in the world of the Kansas legislature, last week the Senate Public Health and Welfare Committee, and the House Health and Human Services Committee, heard twin “Prompt Payment” bills. These would require Managed Care Organizations to assure prompt payment for clean claims within 30 days and payment (or denial) of non-clean claims within 90 days to KanCare vendors. If they don’t pay in a timely manner, they will pay interest upon those delays. Many small providers require immediate payment for services rendered if they are to remain in business. This bill somewhat addresses that. Our statewide advocacy agency InterHab, made some additional recommendations which would strengthen the bills. And…at the local front, I/DD service providers are still learning the ropes of KanCare regarding billing, who to talk to about what, working with care coordinators, and how to define “service”. Slowly but surely, we are making some progress. And speaking of progress, a birthday is just the first day of another 365-day journey around the sun. I need to let you know that I so enjoy taking that trip with you! Warm regards, (Name Withheld)



In other words, the concern over how this is going to work is thick with those of us who care for persons who are disabled.

http://www.kansascity.com/...

Advocates and families of people with developmental disabilities say the state is applying the wrong model. It’s one thing to cut costs for short-term medical care such as an illness, a severe injury or an urgent treatment. It’s another matter, KanCare critics said, to find savings for the disabled, who require a lifetime of assistance. “You are not going to reduce the needs of a person with a very low IQ and very low cognitive skills through some magical insurance formula,” said Tom Laing, executive director of InterHab, which represents groups serving the developmentally disabled. The state says it is focused on improving the quality of care. “We’re not trying to change a person’s disability,” Sullivan said. “That doesn’t mean we shouldn’t strive to improve their physical health, their behavioral health or their employment situation.” The insurance companies say quality care is important, but they acknowledge costs are a factor. UnitedHealthcare spokeswoman Molly McMillen said in an email her company wants to provide a unique population with access to quality care “while being good stewards of taxpayer dollars.”

In other words, providing a profit motive to a third party administrator for the seriously disabled rarely creates profit.. without cutting some corners. Adding a middle management layer with the goal of 'being good stewards of tax dollars' is code word for: less services.

UnitedHealthCare has a unique approach to this in Kansas..

http://www.salina.com/...



Beginning Jan. 1, Salina Regional Health Center will not accept Medicaid patients who receive their benefits through United Health Care, one of three providers in the state. Tom Bell, executive director of governmental and public relations for the hospital, said the hospital has signed contracts for 2014 with the two other KanCare providers -- AmeriGroup and Sunflower Health Plan -- but couldn't come to terms with United. "We tried to get the same terms we had with Sunflower and AmeriGroup, and we couldn't," Bell said. "There were technical aspects of reimbursements that we couldn't get together on. We've worked on getting a contract for most of this year." Because the state is mailing out its annual enrollment packets to individuals starting today, allowing Medicaid recipients to pick among the three providers, Bell said the hospital is trying to spread the word that it won't accept United's plans in 2014. In addition to an ad in this past Sunday's Salina Journal, the hospital is sending letters explaining it won't accept United's Medicaid plan to area health care providers, clinics and other hospitals that might refer patients to Salina Regional.

The same insurance company that is refusing to pay medicaid rates to hospitals to the point that hospitalsis a good sign of where this is headed.

It took a Republican who isn't running for another term to call this for what it is: another stab by a state government to take control of your life with social policies you may not agree with and use your tax dollars to lower your level of care.

That's good for no one, especially those who need it most.

Update: Republicans Spin the Attack on Praeger

http://www.insurancejournal.com/...



State Senate Public Health and Welfare Committee Chairwoman Mary Pilcher-Cook, a conservative Shawnee Republican, said Praeger’s stance on the health overhaul has complicated work on issues surrounding it.

“It’s very difficult to get information that you feel you can trust,” Pilcher-Cook said. Four Republicans have launched campaigns to replace Praeger, all critics of the federal health overhaul. They are Beverly Gossage of Eudora, director of a health insurance consulting company; David Powell, an El Dorado insurance agent; Ken Selzer, a Leawood accountant; and Kansas House Insurance Committee Chairman Clark Shultz of McPherson. Praeger’s political career began in 1985, when she won a seat on the Lawrence City Commission. She served 12 years in the Legislature, most of them in the Senate, before winning the first of three, four-year terms as insurance commissioner in 2002. As a legislator, she broke frequently with conservatives on issues such as abortion, taxes and education but still maintained solid GOP support for her statewide races. Over time, conservatives gained firm control over the party. “I remember, even when I was in the Senate and you could see it beginning to move more conservative, I think we all thought, ‘Gosh, how much more conservative can it get?”’ she said. “And then it just kept getting more conservative.”