State Rep. Dan Hawkins, R-Wichita, made his case against Medicaid expansion in Winfield on Tuesday night during a talk at Cornerstone Church.

As chair of the health committee, Hawkins has been a staunch opponent of expanding the federal/state program for the poor, elderly and disabled. He is now also majority leader in the House.

Nearly two-thirds, 62 percent, of Kansans support expansion, according to a survey released last month by Fort Hays State University. But Hawkins isn’t one of them.

“I’m not a fan of Medicaid expansion,” Hawkins told the crowd of about 60 at the outset. “It’s probably one of the greatest boondoggles in the welfare system.”

Hawkins was introduced by State Sen. Larry Alley, R-Winfield, also a firm opponent of Medicaid expansion. The talk was sponsored by Women for Winfield, a citizens group led by Alley’s wife, Sondra.

Hawkins’ case rests primarily on the cost of expanding Medicaid as he anticipates it. Predictions that Medicaid expansion would bring health insurance to 150,000 Kansans are too low, Hawkins implied. When free health care is made available to adults who earn less than 138 percent of the federal poverty level ($12,000 a year for a single person), they will flock to the program.

He predicted the number of new Medicaid participants might rise to 200,000, costing the state “half a billion dollars” when the initial federal 90 percent share runs out after a few years.

Individuals from neighboring states might just walk across the border to get health insurance without co-pays, deductibles or other out-of-pocket costs This would make it impossible to bring people on waiting lists for developmental disability services into community programs, Hawkins asserted.

“It’s absolutely morally reprehensible to have expanded Medicaid,” Hawkins claimed, “because the Medicaid expansion people would come first.”

But a report issued in December by the Kansas Health Institute suggests Hawkins figures are exaggerated. It estimated expansion would have extended to 74,774 additional adults in 2018.

Hawkins also contends that expanding Medicaid would not save rural hospitals, many of which operate with few patients and cannot survive much longer.

“The day is gone when we’re going to have hospitals in every rural town,” he said.

He asserted that expanded Medicaid would not have saved hospitals in Independence or Fort Scott, and quoted an official of the Mercy Hospital group, of which those two institutions were part, in support of his view.

Two large hospitals, Via Christi and the University of Kansas Medical Center, would reap more than 70 percent of the money from expanded Medicaid, Hawkins said. Critical care hospitals, such as William Newton in Winfield, would, as a group, receive only 7 percent. WNH leadership supports expansion.

“The hope that Medicaid expansion will save rural hospitals is misplaced,” he claimed.

He did not mention the South Central Kansas Medical Center in Arkansas City, and barely mentioned the Wellington hospital, both of which have struggled financially.

The CEO of the Ark City hospital has said Medicaid expansion would add about $1.35 million to its revenue.

In lobbying for expansion,  CEO Jeff Bowman also has cited a study that showed that states with Medicaid expansion were 84 percent less likely to close their hospitals. The report found that states that have expanded the program received a wave of newly-insured patients, while states that rejected it were left with large numbers of uninsured.

“It will further improve access to physician and hospital services for the segment of our population that is currently uninsured, making preventive services and primary care a reality for these individuals,” Bowman wrote in a column last year.

As rural hospitals disappear, Hawkins said, federally qualified community health clinics such as the one in Winfield will be the best way to fill the gap. That clinic treats patients according to their ability to pay and has plans to expand into Arkansas City.

Hawkins also spoke favorably of direct primary care, a growing practice in which physicians are paid a monthly, quarterly or annual fee and provide full medical service including laboratory tests, clinical services and consulting.

Direct primary care allows doctors and patients to avoid the bureaucracy of health insurance. This practice too, can help fill the gap as rural hospitals disappear, Hawkins said.

Hawkins made it clear he did not like the “welfare system” that benefits people who are not likely to vote Republican.

He said he favored work requirements on Medicaid participants, as Kansas has on welfare recipients. He blamed the news media for building political support for such welfare programs and for expanded Medicaid.

“I despise the media,” Hawkins said, “because they lead us down the road like sheep.” He is trying in his own small way to counter that influence, he said.

As for the reported compromise being worked out between Sen. Jim Denning, R-Johnson County, who has a Medicaid expansion bill of his own, and Gov. Laura Kelly, for whom Medicaid expansion is a priority, Hawkins at first said he didn’t know what to think.

Then he predicted Denning would not get what he wants from the deal, especially if the 138 percent of poverty level is included.

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