March 2003
March 27, 2003
(Distributed to Kansas newspapers March 24, 2003)Common sense ideas
Strange things happen when you turn loose a bunch of people on a problem that they don’t deal with on a day-to-day basis. They tend to not know that some things "are just not done."One of those strange things has happened in the Kansas Statehouse: The Senate President’s Task Force on Medicaid Reform, having met for more than a month, has presented a report that contains some common sense ideas that sound doable, some common sense ideas that would cause political nightmares and common sense ideas that are mystifying only because they aren’t being done.
Goal, of course, is to reduce the state’s $1.5 billion (most of that is federal money) outlay on Medicaid, the program for health care and assistance to the poor. The key is that nobody wants to see poor people who are sick or disabled not get health care and live the best lives that they can, but there is probably money being spent that is wasted.
The real issue is that legislators, because they’re not health-care experts, probably wind up cutting the wrong things due to budget pressures instead of pruning carefully to provide good, efficient care to people who need help.
In state government, there is a considerable number of babies thrown out with the bath water just because legislators don’t have the knowledge to understand the differences.
Who has been doing the looking at Medicaid? Sen. Stan Clark, R-Oakley, is leading the group that includes Sens. James Barnett, R-Emporia, Pete Brungardt, R-Salina, Paul Feleciano, D-Wichita, Tim Huelskamp, R-Fowler, and Janis Lee, D-Kensington. Barnett is a doctor, Brungardt an optometrist, and the rest, well they’re non-medical types who just happen to have been elected to the Senate.
So, what sounds doable?
Providing some income tax breaks for Kansans who buy long-term care (that’s basically nursing home and assisted living costs) insurance. Yes, you can buy insurance to pay for your care when you get old, but by the time most people realize that, yes, with a little luck they will eventually get old, the premiums are too high to afford. A tax break here on foresight sounds reasonable, unless insurance companies get too clever and wind up pricing policies based on tax breaks.
What would be a political nightmare? A proposal by the task force to deny eligibility for coverage to people with more than $15,000 of personal property. Sounds OK in theory, but do you want someone from the state poking around your house appraising that lamp, the piano or the DVD player your son gave you so you can watch home videos of your grandchildren? Nope, there are political problems there, but then again, you’d hate to see someone with a $30,000 Tiffany lamp getting Medicaid.
What is hard to believe that the state isn’t doing now? Well, at least a couple things spring from the report. One is that there isn’t a more sophisticated analysis of prescription drugs paid for by Medicaid. It’s a complicated computer programming event, but, for example, there’s no automatic red flag when a Medicaid client is receiving nine or more distinct medications.
Now, nine prescriptions is a lot, and the task force recommended that the state’s pharmacy program managers flag those nine-or-more prescription clients and have someone check to see whether they are all necessary. They might be, but right now, nobody’s really checking. That sounds reasonable.
And because people spend-down their assets to qualify for Medicaid care, the committee wants the state to step up its program of making sure that people who have the money to pay for their own care do it, and not lean on taxpayers for help. Nearly every weekend there are seminars somewhere in Kansas about what amounts to hiding assets so that people appear poor enough to qualify for Medicaid.
Now, most of us would like to be able to pass on to our children a nice estate, but practically, if you can put money in a trust for your children, you ought to be paying for your own health care. You shouldn’t be selling your house to your kids for a dollar so it legally appears that you are a renter or homeless.
So, where does the report go? Surprisingly, there’s still time left in the legislative session for some of the better ideas to be put into law, and there is plenty of time for the Legislature to order agencies to do much of the stuff that doesn’t require laws to be amended.
Will the ideas turn around the state’s budget problem? Nope. But they represent good management of programs that cost the state a lot of money and which, if Medicaid gets too expensive for the state, may be injudiciously whacked when instead there are running adjustments which might make it possible to provide high levels of service to people who need help, and who most Kansans will be willing to help.
March 20, 2003
(Distributed to Kansas newspapers March 17, 2003)
A victory for Kline
Attorney General Phill Kline had a good week last week: A major victory for Kansas, millions of dollars of money that can be spent on good things.All from a lawyer who only kept his license to do lawyer business in good standing when he believed he was going to have to do lawyer business.
The good news is that he has waded in on behalf of Kansas and its taxpayers, and by all accounts won a good settlement of thorny financial issues arising from the sale of Health Midwest property in the KC area to Hospital Corporation of America.
The deal is that Kansas wanted about 20 percent of the proceeds, after debts were paid, from the sale of Health Midwest to HCA.
Early activity indicated that Kansas might be tossed just a wing or a leg from the carving up of that $700 million in free-and-clear cash from the hospital system sale.
Kline jumped in, mobilized the governor and the Legislature, and got the state what appears to be the 20-percent share that Kansas was after, and a separate board of trustees to oversee the spending of that $140 million where it would do the most good for the indigent of Kansas in the area where Health Midwest hospitals were located.
No bones tossed to Kansas from a Missouri-dominated board of trustees, no scrapping over just where Kansas’ share of the money can be spent--and even a prohibition of the Kansas board from spending any of that trust fund money on political activities.
And...it’s worthwhile noting, Kline did all this while a lot of Kansans and Kansas owners of newspapers were lamenting that Kline was going to ruin the deal, that he didn’t know what he was doing and that Kansas was going to see millions of dollars slip away because Kline is a pro-life attorney general and what do they know?
Well, after last week’s tussle, he remains not only a conservative, pro-life attorney general, but one who has a major victory on his hands.
The import of that victory is one that you don’t want to underestimate. With the money from the settlement, there is a very good chance that Kansas will be able to provide health-care services to thousands of Kansans who might otherwise wind up getting Medicaid coverage for their health-care needs. And because the state pays about 40 percent of the cost of Medicaid services, the Kansas foundation may take a load off an already-stressed Medicaid budget.
Or...maybe figure a way to use that money to pay the state’s 40 percent of Medicaid bills, making Kansas money and federal money go further.
This is complicated stuff but it has a lot to do with the state’s budget problems, downstream from the attorney general’s office of course, but a dab of relief clearly attributable to Kline.
It’s not often that an attorney general brings big bucks to the state.
This is pretty heady stuff for Kline, who defeated a nearly white-shoe lawyer, Sen. David Adkins, R-Leawood, in the GOP primary election. Adkins was also the only senator who voted against legislation that may or may not have been helpful in putting together the Health Midwest/HCA solution.
Now Kline has political capital on hand. He did something that few thought he would be able to do and even Gov. Kathleen Sebelius includes Kline among the collaborators in pulling off the Health Midwest victory.
So, where does Kline go now?
Surprisingly, he pretty much stays in his office and does low-key stuff.
He and Sebelius have joined for some tough-on-crime bills that make sense. He’s representing the state in a case against Wyandotte County that involves Sunday sales of liquor, but he isn’t sounding off about evils of drink. He is even staying quiet about allowing non-citizens to get Kansas drivers’ licenses.
Kline isn’t even jumping into the action on the Senate-passed bill that would allow first-time drug offenders to get addiction treatment instead of scarce prison bed space. That’s red meat for attorneys general.
And, the bill that would create new, more strict standards for operation of outpatient abortion clinics? Kline’s for it, but not making waves.
So, what do we make of Kline? Well, he may just be the guy who is attorney general, once he got the job and is doing, in a low-key way, the stuff that we elected an attorney general to do.
So far...
March 13, 2003
(Distributed to Kansas newspapers March 10, 2003)Girl vs. the Boys
We are going to know, probably in the next couple of weeks, who wears the pants in the Statehouse.
There is a complicated political storm brewing over the state’s falling revenues and at the end of it, we’re going to know whether Democratic Gov. Kathleen Sebelius has won the hearts and minds of her state or whether "the boys" (House Speaker Doug Mays, R-Topeka, and Senate President Dave Kerr, R-Hutchinson) are really running things.
This is going to be subjective, and everyone gets to choose his or her own winner, but those choices probably will mean the difference between Democrats picking up more legislative seats at next year’s elections, or Republicans picking up seats.
Here’s the situation:
Sebelius ordered up last week an informal look at future state revenues. It shows that this fiscal year, which Sebelius inherited, $105 million has to be cut from the budget between now and June 30, when the fiscal year ends. And it shows that Sebelius has to make up $125 million in shortfall in her very own, "did it all myself" budget for the fiscal year that starts July 1.
Immediately, Sebelius gets points for ordering the informal, early peek at revenues. That sounds like a responsible thing to do. It gives her a look at the trends of revenues, so she can start making plans on how to deal with it, either by suggesting tax increases or new revenues or by cutting spending.
Now, her informal "peek" isn’t the official revenue estimate which sets the hard-and-fast budget-ending numbers, but it is probably useful.
Where were "the boys?" Well, they didn’t want to participate in the peek. They stopped just short of making fun of it, but they are saying, essentially, that they are only interested in the final budget numbers, which will be produced April 22, shortly before the Legislature is scheduled to adjourn.
Everyone under the Statehouse dome knows that the April 22 numbers are going to be at least as bad as last week’s informal numbers, but it appears that the boys would rather wait for the official bad news rather than get an idea of how bad it is likely going to be, and start reacting now.
How does that sound to you? Take a peek now, or drive with your lights off and wait until April 22 to see what you are about to hit?
Railsters are betting that the public is going to go with Sebelius on this one, notwithstanding the boys saying that they are willing to wait until near-adjournment to see what has to be trimmed from the state budget.
Oh, and let’s add another dimension to the puzzle. Sebelius is going to travel to seven cities this week to explain the expected revenue drop, and lay out the case that this is worse than anyone expected. That’s a support-gathering mission that politically has a big up-side. People will begin to "own" the problem, or at least share it with the governor and probably start wondering what can be done.
Meanwhile, the boys will be in the Statehouse.
Wondering about the "girl vs. the boys stuff?" Well, remembering growing up in a neighborhood dominated by girls, it seemed that the girls spent more time trying to get everyone to understand and assess the problem before anyone unilaterally threw out a solution.
The girls assembled the solution from a lot of bits of information...then told the boys what to do. And, yes, we generally did it.
Girls have been doing that since the first one showed up, if we recall our history correctly.
That might be the idea behind the governor’s fly-around. To provide the biggest possible opportunity for Kansans to empathize with her budget problem, maybe offer some suggestions, but at least learn how serious a problem the governor has to deal with.
There’s something to this cultural girl vs. boy thing that is going to play out subtly over the next couple weeks.
The hardball part of the budget dilemma? Well, Kerr is already holding a light to the issue, saying that Sebelius campaigned on four promises: Not to raise taxes; not to cut aid to K-12 education; not to cut aid to higher education, and to build all the highways that a previous administration promised.
He’d like to see her have to swallow her words, admit that she tricked the public just to get elected, and that she is a failure.
But, practically, the gubernatorial race last year wasn’t about grand ideas or visions of the future. It was a contest between a couple of people who just wanted to be governor.
There wasn’t much detail, nobody wanted to cut education spending or raise taxes or not build highways. They just wanted to be governor, and Sebelius won.
Can the boys paint Sebelius as a trickster, a snake-oil purveyor who now will have to backtrack on her promises?
Not if she can generate enough public understanding of how things keep getting worse and get the public on her side in trying to think up things to make the budget work and to release her from some of those campaign promises without feeling betrayed.
We’ll see how this one comes out. The budget dollars? They’re going to have to balance one way or another. It’s the assessment of blame that is the real battle here.
March 6, 2003
(Distributed to Kansas newspapers March 3, 2003)The real issue...
Sometimes there are so many below-the-waterline issues tied up in a bill that you have to wonder whether the reasons for passing it are what you read in the headlines or what is never mentioned.
Well, we got us a bill like that this session.
The bill, which has passed the Senate, is one that simply eliminates next year's Kansas presidential preference primary election. The reason, ostensibly, is that it would cost the state about $1.75 million to hold the primary election and the state doesn't have that much money lying around for what in a Republican-heavy state probably is going to turn out to be a tribute to President George W. Bush.
Gov. Kathleen Sebelius didn't put the money for the election in her budget for next year, and she is scrambling around to find enough money to run the essential tasks of the state and clearly doesn't have money to spare.
For Republicans that makes sense. There is probably no way that Bush isn't going to be nominated handily because he isn't very likely to have a primary election opponent.
For Republicans, Bush wins, but stands the chance of being embarrassed if he doesn't get a lot of votes. Enough Kansas Republicans, for one reason or another, may decide that he's going to win the primary without their support. A low-percentage win, then, turns out to be embarrassing for Bush. Embarrassed enough, and the Kansas delegation to the Republican National Committee might wind up with bad seats on the convention floor, or maybe a hotel where you have to ride a bus for an hour to get to the convention at Madison Square Garden in New York. Either are bad mojo for Kansas Republicans.
Now, Democrats, who like the idea, generally, of a presidential preference primary in Kansas for the chance that it might bring some Democratic candidates to Kansas to campaign, would like to see the primary held, and figure that in a budget of billions of dollars, there's surely a couple million bouncing around somewhere to finance the election.
Like the primary? Don't like the primary? There are probably good, high-sounding reasons to hold it. Citizen involvement and such figure into the mix.
But, the real issue here isn't the presidential preference primary. It's the date of the Kansas primary election next year, which was tossed into the bill on the Senate floor and which is politically more important than the presidential preference primary.
Currently, remember, the Kansas primary election is held in early August (the presidential preference primary would have been in the spring), and political lore has it that the early August primary election date turns out a conservative crowd that plays into the hands of conservative Republicans in the primary elections.
Last year, when voters went to the polls on Aug. 6, they elected Tim Shallenburger the Republican nominee for governor and Phill Kline the Republican nominee for attorney general.
And those nominations of conservative Republicans, some in the party believe, set up two general election wins: Sebelius for governor because the press had demonized Shallenburger, and Kline for attorney general because Democrats misjudged the anti-conservative bent of much of the Republican Party and didn't get behind Democratic attorney general candidate Chris Biggs early enough and seriously enough.
So, moderate Republicans would like to see the primary election date turned back to near-September so that they can have what they consider a more moderate Republican voter pool to choose their nominees for office.
Next year, of course, there aren't any statewide state offices up for grabs, but moderate Republicans would like the chance to nominate pro-choice, moderate Republicans to run in the 2004 general election for the Legislature.
The state has made early voting convenient for liberal and moderate Republicans. The theory is they vote before taking off for a late family vacation or they get to avoid venturing out of their sport utility vehicles in the heat. But not enough moderates have taken that opportunity.
So, buried deep in the bill that cancels the presidential preference primary is a provision that moves the primary election date for Kansas to the first Tuesday after the fourth Monday in August.
By that time, vacations are over and kids are getting back to school. Moderates who didn't or wouldn't vote in early August are ready to play politics and elect like-minded Republicans to represent them in the November general election.
Where are Democrats in this fight within the Republican Party?
Surprisingly, some are supporting the move to a later primary election date on the basis that more people will vote, the true sentiment of more Kansans will be sampled, and democracy will be served.
That's pretty noble stuff.
Democrats are, though, for all their nobility, probably better off with an early primary election. There aren't a lot of legislative Democratic primaries in Kansas, and in most districts where there are real Demo primaries, it is often in districts where Democrats hold the majority of the votes anyway, so the primary election turns out to yield the eventual winner of the legislative seat.
Even in a Republican-tilted state, Democrats do better running against a Republican who is more conservative than the majority of Republicans in the district.
And the presidential preference primary? Actually, if the bill to cancel it next year didn't contain the provisions to move the primary election, it wouldn't be worth arguing over.