(Syndicated to Kansas newspapers April 28, 2014)
OK, we’ve heard lots of talk about the Interstate Health Care Compact bill that Gov. Sam Brownback signed into law last week with no formal ceremony where he could write his name while surrounded by fans of the measure.
He might have signed it in his car—it’s not texting, after all—or maybe on his way out the door to lunch, but he signed it and now we get to see whether it was worth the ink.
Key is that several other states have enacted laws to join that compact, which is supposed to cajole Congress into essentially giving up its authority over Medicare and Medicaid (we call it KanCare in Kansas now) and just send the states a check each year for what the federal government would have spent in Kansans for health care that is federally funded. That’s Medicare and Medicaid, but not anything that is related to the Veterans Administration or the Department of Defense or Native Americans.
Now, that’s probably a tipoff, the exclusion of the military and veterans and Native Americans. If there is a group of Americans that no politician is going to risk upsetting, it’s veterans. They defended the country—at federal expense—and no state-level politician is going to even appear to meddle in their affairs. It’s easier to rail against Congress for not taking care of veterans than to manage their health care and treat them like non-veteran Americans. Native Americans? They have their own reservations in the state, where some state law doesn’t even apply.
If the compact, which Congress is unlikely to approve, won’t deal with veterans’ health issues, does it make anyone wonder how those states will deal with the health issues of other Americans? Best estimates are that the federal government spends about $7 billion in Kansas—that’s more than Kansas spends from its general fund on everything else.
But a key maybe that the compact gives legislatures the authority to suspend federal laws dealing with health care and substitute its own laws. Would that be like KanCare which is aimed at the poor, or would it be something different? Would there still be “gap” coverage, those individually purchased policies to fill the needs that Medicare doesn’t cover?
Remember, for KanCare, there are still waiting lists for services to some who have disabilities. Any Medicare recipients who paid into that program for most of their working lives who want to be on a waiting list for services that Medicare provides now?
It’s tricky, this compact business: While state rights are politically attractive in Kansas, so is the health of Kansans. There are already lawmakers who voted against the compact who wonder whether, if something expensive happens in Kansas, could some of that health-care money be scooched into other programs?
Now, this might, if Congress approves and the Legislature gets more authority over money it doesn’t now control, turn into a good deal that will provide Kansans who depend on federal programs better health-care services. It’s possible.
But you have to wonder why lawmakers won’t put veterans into the compact. Is there something to be learned here…?