Rural Kansas superintendent makes personal plea for Medicaid expansion

TOPEKA — For Rex Bruce, the prospect of Medicaid expansion is personal.

The superintendent for the Sublette school district has stage four prostate cancer, and his wife suffers from anaphylaxis shock, which causes her throat to shut off. There are times they would have died if they didn’t live within a few miles of an emergency room.

But Bruce worries about the financial stability of the hospital in Satanta, population 1,100, six miles away from him in southwest Kansas. Data from the Center for Healthcare Quality and Payment Reform shows the hospital operated at a loss from 2017-2019. If the hospital were to close, Bruce said, he would have to drive at least 35 minutes to get urgent care.

Bruce and others taking part in the Alliance for a Healthy Kansas push for Medicaid expansion say rural hospitals would realize much-needed financial benefits by joining the surrounding states in extending government-funded health care coverage to more low-income families.

A new report from the CHQPR indicates 47 rural hospitals in Kansas are in immediate risk of closing.

“I’ve got a strong reason to support this,” Bruce said. “We’ve got to keep our our local hospitals open and health care centers, because it’s just too crucial for people to stay alive.”

The 2020 election results severely diminished the chances of passing Medicaid expansion in Kansas, which conservative Republicans have blocked for the past decade. Former Gov. Sam Brownback vetoed a Medicaid expansion plan in 2017, and Senate leadership prevented a plan passed by the House from getting a vote the past two sessions.

Under the Affordable Care Act, the federal government pays for 90% of the cost of Medicaid services for states that agree to expand eligibility to families earning up to 138% of the federal poverty level. So far, 38 states have agreed to expand Medicaid.

The Kansas Department for Health and Environment estimates 165,000 children and adults in Kansas would benefit from Medicaid expansion, an estimate inflated by the financial impact of the COVID-19 pandemic.

“After the elections last fall, it became much more difficult for us to get this through the legislative process,” said April Holman, executive director of the Alliance for a Healthy Kansas. “At the same time, there are dozens of communities across the state who are being represented by elected officials who are not putting those practical considerations and the needs of their constituents before politics.”

In addition to his personal health, Bruce is concerned about the hourly employees in his public school district who aren’t offered health insurance. They make between $16,000 and $20,000 per year and can’t afford to buy health insurance on their own.

In recent years, Bruce said, employees have gone to Mexico to seek health care. One woman left to get treatment shortly before the pandemic and then, because buses weren’t running, stayed in Mexico for six months before returning.

“It hurts me as a superintendent to have some of our quality employees gone, seeking health care that they can pay for,” Bruce said. “I’d love to be able to have a way for these people to get their health coverage and their checkups locally, at our clinics and hospitals.”

Trisha Purdon, executive director of the Montgomery County Action Council, an economic development organization, said the lack of Medicaid expansion in Kansas hurts efforts to recruit businesses.

Coffeyville in particular is at a disadvantage in southeast Kansas, Purdon said, because the community is losing workers to Oklahoma, Missouri and Arkansas, states that have expanded Medicaid.

Purdon said Montgomery County lost 1,600 available workers in a span of 18 months because the Independence hospital closed in 2015.

“Workforce is critical, but if that workforce is unhealthy due to the lack of available affordable health care, the community loses its ability to even compete for new jobs,” Purdon said.

Keith Rickard, executive director of the Guidance Center, a community mental health center serving Atchison, Jefferson and Leavenworth counties, said the state’s mental health system will collapse without Medicaid expansion.

Medicaid provides about 80% of total funding for all mental health centers in Kansas, Rickard said. Those 26 centers would have reduced services if not for COVID-19 relief aid. Without additional funding, they will be forced to reduce services.

“We know what happens when that occurs,” Rickard said. “Those clients end up with law enforcement, as well as emergency rooms. And that’s happening today in unprecedented ways. And that could only get worse if we don’t see enhanced revenues.”

Allison Mulch, director of nursing for Goodland Regional Medical Center, said the hospital had to write off $1 million in 2018 and $800,000 in 2019 because people couldn’t pay for health care and had no insurance.

The 25-bed critical access hospital in northwest Kansas isn’t in danger of closing for now, Mulch said, but financial stability is always a concern.

“When residents don’t have to worry about paying for an office visit or clinic visit, they’re more likely to to go to the clinic and get treated for their chronic conditions or acute conditions earlier where treatment costs the health industry a lot less money,” Mulch said.