State Medicaid reform: 'Rubik's Cube'

State Sen. Roger Reitz squared off Monday with Lt. Gov. Jeff Colyer about prospects for significantly curtailing the cost of Medicaid services without undercutting quality of patient care.

"I don't see how it can possibly work," said Reitz, a Manhattan physician. "You're going to have people marching on the Statehouse."

Colyer, a surgeon and chairman of Gov. Sam Brownback's task force on  reform of Medicaid, said he couldn't concur with the senator's diagnosis.

"I respectfully disagree," Colyer said.

"I'm sure you do," Reitz replied. "You're never going to cut medical costs down. You know that."

So it went during a back-and-forth hearing conducted by the House-Senate Health Policy Oversight Committee into preliminary findings of the executive branch's research on overhaul of the health program for low-income Kansans. The objective is to guarantee a safety net for patients and diminish costs to taxpayers.

Colyer said rising expenditures — a projected 400 percent from 2000 to 2019 — placed an unsustainable burden on Kansas government. He stopped short of unveiling  Brownback's preferences for reform, but summarized ideas likely to be in the mix during the 2012 legislative session.

It would be impossible to overstate the complexity of reshaping a program involving vulnerable patients and medical providers, as well as state and federal governments, he said.

"This is the ultimate Rubik's Cube," said Colyer, referring to the world-famous toy.

The lieutenant governor said there was no realistic way to avoid budget reductions in Medicaid, but he declined to comment on speculation by Rep. Jim Ward, D-Wichita, that the target ranged from $200 million to $400 million.

Colyer said the state likely would absorb hundreds of millions of dollars in federal aid cuts during the next few years.

"We are going to have to make some cuts," Colyer said. "Everybody is going to end up sharing."

He said critics of Medicaid spending reductions should consider an alternative centering on deeper reductions to K-12 and university education.

The Brownback administration is committed to creation of a financially sustainable Medicaid program that involves "high-quality, holistic care and promotes personal responsibility," Colyer said.

Colyer said he would prefer to avoid cutting people out of Medicaid. Missouri, for example, trimmed 100,000 from its list.

Other options include reductions in medical provider rates and conversion to a managed-care model that assigns coordinators to care for patients with the most complicated medical conditions. Targeting the most complex medical cases makes sense, he said.

"Twenty percent of the Medicaid population consumes 80 percent of the resources," Colyer said.

Obtaining a policy waiver from the federal government, which jointly finances Medicaid, would allow Kansas to implement unorthodox reforms, Colyer said.

The Medicaid system is plagued by mountains of paperwork that would benefit from greater reliance on computerized health records, Colyer said. Strategies to delay or prevent people from entering nursing homes should be a priority, he said.

"Our goal," he said, "is to save money by getting better results and avoiding institutionalization."

He said patients should be offered incentives to stop smoking or diet effectively to counter obesity. At the same time, he said, the Kansas could leverage state programs to help people with disabilities obtain jobs and private health insurance.