In my home county of Scott, Kansas, the hospital is closed on weekend, and mostly after 5PM weekdays. The emergency room stays open, but as they tell you, doctors aren’t on site 24-7, though they could be called upon need.
Warnings given to patients upon the door include a statement that due to issues with Kansas Medicaid, not all services are covered, and the patient, in the end, is responsible for all bills generated at the facility.
On Thursday night, following the table of the veto override, I set out into the communities of Kansas I knew would be impacted most directly by the Governor’s veto. What would happen next? Stopping at a small gas station on my way to Johnson City, local residents told a story of a ladder accident and how fortunate they were to have the nearby hospital. Johnson City hospital isn’t one of those considered in immediate risk, but pressure brought on by nearby hospitals that are struggling is certainly changing the makeup of what happens next.
“I don’t know what the Governor is thinking..” said a teller, identified as a “proud Republican”, it was a conversation I would have in over 13 cities throughout Western Kansas. “Who wants to be Independence?”
The potential loss of a hospital, as occurred in Independence, was certainly a sentiment felt at every stop on my journey. In a small bar with a large “TRUMP-PENCE” sign outside not far from Utica, Kansas, the political leanings were certainly conservative. But even there, the decision of what would happen next on Medicaid expansion wasn’t so certain — nor as favorable to the Governor as you’d think.
Jim Denning, R-Overland Park, argued in front of the body that he didn’t understand how Medicaid expansion could “generate a positive fiscal note. No one pays copays, and hospitals would accept less on the dollar, how would you generate a positive fiscal note?”
While I toured hospitals in Western and Central Kansas, legislative forums expressed the anger of Kansans as to what happens next:
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Jake Wall, a younger Topeka resident who drove to Silver Lake for the forum, said he was concerned about what could happen to certain people if Kansas does not expand Medicaid.
"You have hospitals that are closing. You have wings of hospitals that are closing. That's today. What's it going to be like tomorrow if you don't expand Medicaid?" he said. "Where are the seniors supposed to go? My parents, I'll let them come live with me if they have to. But some people don't have family."
In almost every hospital I’ve visited, one wing is almost a requirement: service for continuing care. While House & Senate Republicans have chastised the bill for helping “the able-bodied” hospitals are servicing the able-bodied on a daily or weekly basis. These units, in many cases managed by a Nurse Practitioner or a single doctor, look after immediate need — cuts, accidents, sudden illness. But they also care for ongoing conditions like diabetes and post procedure care. The message heard loud and clear was that as certain Kansas Republicans attack the “able-bodied” they simply don’t understand how long term illness doesn’t always qualify as a disability and can shape a person’s financial life. From diabetes to cancer, able-bodied individuals could find themselves suffering real illness — and while some may require travel to a larger hospital, many of these smaller hospitals help effectively manage post care treatment. Without them, patients would be required to abandon their family home and assets to move closer to facilities that could treat them, dividing them away from their family.
In efforts to hold together mid-sized communities at a greater distance from the top medical facilities in the state, more and more facilities have taken in long term care units, continuous care and even some attached housing options. Many of these patients are also recipients of Medicaid. Why do it? Not only to hold their community together, but because Medicaid disbursements are often what they need to make sure the doors stay open in the rest of their facility, and the residents and town know it well.
House leader Republican Don Hineman (R-Dighton) knows well the problem these communities face. While city Republicans debate stand the strongest firmly opposed, it is rural Republicans who can see things changing, and not for the better.
On Monday in the state house, a way of life in Kansas stands up for a vote. Should the Kansas state legislature vote to overturn the Governor’s veto, options for healthcare service for many stays an option. Without it, several hospitals aren’t sure what happens next.
Facilities like the Southwest Kansas Regional Care facility in Liberal, Kansas have seen growth by attracting in doctors with diverse backgrounds and skills, but local skills providers will tell you that skill labor without good insurance still remains an issue. The influx of Medicaid expansion? It’s a more than welcome change.
Calling expansion a “critical issue” the Kansas Hospital Association knows that too many Kansas hospitals are hanging on, hoping for change.
But for the communities themselves, the loss of a hospital is more than the loss of jobs and facility, it’s a community killer.
On Monday, rural Republicans — most of whom voted yes on Medicaid expansion — get to discover whether or not city Republicans actually care about what happens to their communities or not.
If the legislature can override the Governor, hospitals can see positive change coming. Without it, uncertainty lies ahead.