By Chad Moore*
November 21, 2008
The Kansas Health Policy Authority1 (KHPA) Board of Directors approved its health reform recommendations on September 16, 2008. These recommendations essentially pick up where the health reform debate ended at the close of the 2008 Kansas Legislative Session. In 2008, the KHPA recommended twenty-one health reform proposals focused on the following goals: prevention, personal responsibility, and providing and protecting affordable health insurance. Of the twenty-one proposals, nine were passed and/or funded by the Legislature. These nine proposals included:
- Statutory definition of a "medical home;"
- Expansion of the KHPA Board of Directors to include the Kansas Commissioner of Education;
- Movement of the Small Business Grant Program from the Department of Commerce to the KHPA ($150,000 State General Funds, SGF);
- Standardization of insurance cards for public insurance programs, i.e., Medicaid;
- Expansion of the Community Health Record (CHR) from a pilot project to a statewide initiative ($384,000 SGF);
- Addition of dental care benefit for pregnant women who are Medicaid beneficiaries ($546,000 SGF);
- Providing some tobacco cessation support for Medicaid beneficiaries (limited to pregnant women only);
- Expansion of HealthWave (the Medicaid and SCHIP managed care program) outreach to children to assist in increasing enrollment of eligible kids ($550,000 SGF); and
- Improvement of school health coordination by promoting physical fitness/activity/nutrition through the Coordinated School Health Program ($550,000).2
Looking ahead to the 2009 Legislative Session, which begins in Kansas on January 12, 2009, the KHPA Board is again focused on overall health reform, not simply healthcare reform. It has identified a number of priorities such as:
- Recommending that the Legislature enact an indoor statewide smoking ban in public places, allowing Kansans to work together without exposure to deadly secondhand smoke;
- Recommending instituting an increase in the tobacco user fee to decrease tobacco-related illness and death; and
- Recommending that tobacco-user fee dollars be used to fund programs to provide cost-effective health insurance and promote public health, including:
- Expanding Medicaid to include parents earning up to 100% of the federal poverty level or $1,467 per month for a family of three;
- Improving access to affordable health insurance for small businesses and young adults;
- Implementing a statewide Community Health Record;
- Expanding programs such as: (1) early detection for breast, cervical, colorectal, and prostate cancer to prevent illness and death from failure to timely detect those diseases;
(2) coordinated school health program; and (3) wellness programs for small business; and
- Expanding access to tobacco cessation programs for all Medicaid recipients.3
The current excise tax on a pack of cigarettes in Kansas is $0.79; however KHPA estimates that it costs Kansans the equivalent of $0.86 per pack of cigarettes to address the costs associated with tobacco-related illnesses of Medicaid recipients alone.4 The KHPA's proposal recommends an increase in the tobacco user fee by $0.75 per pack that would provide approximately $68.7 million in revenues in fiscal year 2010.5
KHPA has recommended that any revenue generated by a tobacco user fee increase be used to implement its health reform proposals. However, the budget projections in Kansas are unfavorable at best. Governor Kathleen Sebelius recently asked many state agencies to cut current year spending by 3%. Earlier this month, state budget estimators concluded that revenues this fiscal year would fall short of scheduled expenditures by $211 million, mostly due to the faltering stock market's impact on capital gains and the tax dollars they generate. Sales tax collections also have been slightly off, which the economists also attributed to the lagging economy.6
With such a tough budget forecast, KHPA's health reform recommendations that require no legislative appropriations may have the best chance of passage during the 2009 Legislative Session.
1 The Kansas Health Policy Authority was created through legislation on July 1, 2005. It is a nine-member board, including healthcare, business, and community leaders appointed by the Governor and the Legislature, as well as seven ex-officio members that include State Cabinet Secretaries and the Executive Director of KHPA.
2 Kansas Health Policy Authority Legislative Session-at-a-Glance.
3 Kansas Health Policy Authority Newsletter, KHPA Pulse, October 1, 2008.
4 Kansas Health Policy Authority 2008 Health Reform Community Dialogue Tour paper.
6 KHI News Service, "Governor Orders Deeper Budget Cuts," by Mike Shields; November 5, 2008.
*We would like to thank Chad Moore (Children's Mercy Family Health Partners, Kansas City, MO) for providing this email alert.