For most of this year, I simply haven't had the stomach to cover the health care debate, because so little of what has been discussed has been relevant, with discourse better suited for a demolition derby- combatants hurling their outdated auto bodies at their enemies, rending their own steel and rubber in the vain hopes of paralyzing the opponent. There's plenty of room for disagreement and discussion on the various health bills before the Congress, with wide-reaching policy and fiscal implications, and we're stuck on whether Nancy Pelosi is going to administratively execute your grandmother.
We, however, are not going to waste any more time on that. Personally, with all the discussion on whether states could/should opt out of the program, I'm getting interested in what implications would be in place for given states. Thankfully, we have just that for Kansas, thanks to Rep. Lynn Jenkins, who formally requested that the Kansas Health Policy Authority (KHPA) analyze both HR 3962 and S. 1796, both of which are currently making the rounds in Congress. The KHPA, for its part, stated their interest as “estimating the impact on the state is tied directly to the Agency’s role in making sure Kansas is positioned to benefit and succeed should reform pass the Congress.” Sounds pretty impartial to me. But just to make sure, they contracted an independent actuarial agency to do the numbers. What they found is striking.
Beyond all the talk of unfunded federal mandates and busted budgets, the KHPA found that Kansas actually stands to save money with either of these bills in force- caveats depending, of course. I'm going to try and break it down to some basics, but I strongly encourage you to read the KHPA's report for more detail.
Under “a fairly wide range of assumptions,” and keeping in mind the previously-mentioned caveats such as the size of Medicaid expansion from the 'woodwork effect,' the KHPA projects reductions in net state expenditures by at least $25-50 million per year under the Senate bill. Even on the low end, if projections are found to be woefully underestimating the need for medical care, savings of $10-20 million annually are expected.
The House bill presents significantly less savings to the Kansas budget, due in part to the mechanics of the bill, including a larger expansion of Medicaid. Nonetheless, KHPA estimates a savings of between $0 to $25 million per year. However, on the low end of the scale, there is the possibility that HR 3962 could cost Kansas up to $5-15 million annually.
The takeaway from this brief analysis is that the health care bills are far more complex than many of our Senators and Representatives would like us to believe. It would be undoubtedly a good thing to increase coverage while reducing costs. The question lies in whether these are actual reductions in cost, or a shifting of the burden from state budgets to federal ones. However, these specific numbers may be a moot point. At this time, these bills should be considered very much of a moving target; what emerges from negotiations, debate and conference committee could bear scarce resemblance to what the KHPA has analyzed in detail. Nonetheless, we would do well to look into these bills with great detail in the weeks and months ahead, and consider the impacts for each of our own states.
