Hospital association president says gaining lieutenant governor’s support key to moving issue forward
by Andy Marso, KHI News Service
Lt. Gov. Jeff Colyer met with freshman legislators, hospital officials and even Kansas bishops to discuss Medicaid expansion last session.
Colyer, a plastic surgeon and former legislator, is Gov. Sam Brownback’s point man on health policy issues, including the switch to Medicaid managed care under KanCare.
Tom Bell, president and CEO of the Kansas Hospital Association, said convincing Brownback to expand Medicaid eligibility in Kansas will be difficult without Colyer’s support.
“My sense is that the lieutenant governor is a big part of the health policy development process in this administration,” Bell said.
Colyer did not testify last session when the Legislature held its first-ever public hearing on expanding Medicaid under the federal Affordable Care Act. But his appointment calendar during the session, obtained through an open records request, shows he was involved in the discussion.
Medicaid discussions
Colyer had a meeting about Medicaid with first-year legislators over the lunch hour on March 9. That was two weeks after Republican House leaders reluctantly agreed to schedule the expansion hearing and a few days after Brownback revealed that he was open to signing on to Medicaid expansion if it was budget neutral.
The hearing on expansion took place nine days after Colyer’s meeting with legislators. Susan Mosier, secretary of the Kansas Department of Health and Environment, testified that the expansion plan not only had to be budget neutral, the state also had to eliminate Medicaid waiting lists for support services for people with disabilities before expanding Medicaid medical coverage to low-income Kansans.
In an Aug. 20 interview, Colyer said the meeting with the first-year lawmakers was part of a series of educational sessions arranged by House Speaker Pro Tem Peggy Mast, an Emporia Republican. He said he mainly went over the basics of Medicaid.
“A lot of people didn’t understand that Medicaid is not just the medical side, it’s dealing with disabilities, long-term care and getting a lot of those basics there,” Colyer said. “The feedback we got from people is they want stability in the program, and that means financial stability in the long run. And they want us to continue to work on outcomes within the program.”
Colyer said he did not recall talking with the legislators about eliminating the waiting lists for home and community-based support services as a condition of considering Medicaid expansion. But he said the idea was not new.
“That had been a comment for a long time from the administration,” he said.
Colyer’s calendar shows that he had a conference call about Medicaid expansion with the four bishops who lead the Roman Catholic Church in Kansas on the morning of April 10.
The religious leaders previously declined to weigh in on the matter. Three weeks after the conference call they released a statement offering support for Medicaid expansion, despite reservations about cost and contraception coverage.
Colyer said the bishops did not tell him they were going to come out in favor of expansion during the call, but it was clear they were considering the issue and wanted more information.
“We told them what was going on and what we saw and shared with them some of that information about financial implications … and I think they learned some things from us too,” Colyer said.
The same day the bishops released their statement — April 30 — Colyer met for 45 minutes in the governor’s office with officials from the Kansas Hospital Association to discuss expansion.
The hospital association is a leading proponent of expansion, saying it would bring its members a much-needed infusion of federal cash, while providing medical coverage to an estimated 150,000 Kansans.
Bell said the association’s leaders have had a number of conversations with Colyer, including some involving Brownback.
Bell said Colyer was always cordial and willing to talk, but when the issue of Medicaid expansion came up “there was never an overwhelming amount of interest in having that discussion.”
Overcoming Colyer’s opposition is almost a prerequisite for moving forward, Bell said.
“I think the short answer is it would be very difficult to do something in the area of Medicaid expansion without the lieutenant governor buying into it,” he said. “We think there’s a lot of things that have been put on the table that he and the governor ought to buy into.”
Lots of redactions
The request for Colyer’s calendar was made under the Kansas Open Records Act. The documents provided included redactions on every page, with select Colyer events blacked out almost every day.
Explanations were not provided for each individual redaction, but in an email Eileen Hawley, the governor’s director of communications, universally cited three broad exemptions to the state open records law:
• Records that are “not related to functions, activities, programs or operations funded by public funds.”
• Records that are considered “notes, preliminary drafts … or other records in which opinions are expressed or policies or actions are proposed.”
• Records that contain personal information that, if released, would “constitute a clearly unwarranted invasion of personal privacy.”
King v. Burwell prep
Besides Medicaid expansion, the biggest ACA issue for states this year was a U.S. Supreme Court case, King v. Burwell, that threatened to pull federal health insurance subsidies from residents of states like Kansas that had not established their own marketplace to sell plans.
Colyer was busy with that last session too.
He was in Washington, D.C., on Jan. 16 to speak at a U.S. Senate health policy “boot camp” titled “Making the States Partners in Health Care Reform.” After the formal presentation, Colyer had a meeting with Brian Blase, a health policy analyst for the U.S. Senate Republican Policy Committee.
The calendar says Colyer and Blase discussed a possible Republican response to the King v. Burwell ruling. If the plaintiffs were successful in the case, the loss of subsidies may have forced millions of Americans to drop their coverage.
Nationally, Republicans were in a tricky spot politically. Most did not like the federal health reform law, but if they didn’t have an alternative ready they risked angering suddenly uninsured voters.
The court ruled for the defendants in June, leaving the subsidies in place.
But in the run-up to the decision, speculation was rampant as to what political leaders would do for those whose insurance costs would suddenly spike if the subsidies were taken away.
In Kansas, about 77,000 people relied on those subsidies. The Legislature made no move to protect them during the session, but Eileen Hawley, the governor’s director of communications, said Colyer and Brownback stood ready with a “market-based solution” should the subsidies disappear.
Colyer said if the King v. Burwell decision had gone the other way, most of the decisions about how to proceed would have to be made at the federal level.
“In many ways we were captive to them, so we just had to be ready for a lot of contingencies,” Colyer said. “There were all sort of discussions in D.C. about what they would do. … We were certainly ready to deal with whatever contingency we would face, but we didn’t know it what it was and there wasn’t one, so it’s all hypothetical.”
Meetings with donors
In addition to his key role on health policy, Colyer had several meetings with people who donated to the 2014 Brownback-Colyer re-election campaign.
His calendar shows he also met with Art Pope, a Republican mega donor, during an April 13 trip to North Carolina. Colyer was in Raleigh that day to speak about KanCare at a panel discussion about Medicaid reforms hosted by the John Locke Foundation, a conservative think tank.
Colyer made three personal loans of $500,000 to the 2014 campaign.
The campaign repaid Colyer for two of those loans. But he said late last month he was still owed about $100,000 from the last of the three loans.
“Yeah, we’re still working,” he said.
The loans were part of a federal investigation, according the Associated Press. But prosecutors announced in June that they didn’t intend to file any charges.
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