Disagreement over how and how far Kansas officials should push back against the Patient Protection and Affordable Care Act, popularly known as Obamacare, is creating tension within the state GOP. It mirrors the national tension between veteran Republican Party members working within the existing political system and tea party or other grassroots activists demanding an end to business as usual.

That disagreement has already cost a freshman Kansas House representative an important legislative committee seat and will likely surface as the Kansas Republican Party State Committee meets in Wichita Saturday.

The GOP committee will adopt one of five resolutions expressing the state party’s opposition to Obamacare. Four originally demanded the state return federal grant money intended to set up a health care exchange to implement the law.

Those resolutions need a rewrite after Governor Sam Brownback announced Tuesday that he’s sending back a $31.5 million federal Early Innovator Grant (EIG) from the U.S. Department of Health and Human Services.

Kansas was one of seven states accepting the grant and joins Oklahoma as the second state to send it back.

Kansas Insurance Commissioner Sandy Praeger applied for the grant in December. The grant essentially serves as a carrot for states willing to take the lead in implementing Obamacare through a state health exchange.

Sen. Mary Pilcher-Cook, R-Shawnee, said, “Kansas was being used as an example because Insurance Commissioner Praeger is a Republican and close friends with HHS Secretary Sebelius.”

Praeger, according to a March 23 Politico story, is the only statewide elected official supporting Obamacare.

Kansas Democratic Party Chair Joan Wagnon called Brownback’s decision “foolish” and “kow-towing to the extremists.” The extremists she’s referring to, mostly leaders of local tea party or other grassroots groups are promoting resolutions demanding even stronger action.

Brownback is still catching most of the fire from some grassroots group leaders over Obamacare and the health exchange. Brownback reiterated his opposition today in a statement on the 11th Circuit Court of Appeals’ ruling (pdf) that the individual mandate of the Affordable Care Act is unconstitutional.

“The decision confirms what I have believed all along, that Congress does not have the power to compel Kansans to participate in healthcare finance schemes against their will.  This is why I voted against the Affordable Care Act as a United States Senator, this is why I signed the Kansas Healthcare Freedom Act into law protecting the freedom of Kansans to make their own healthcare decisions, and this is part of why just this week Kansas became the second state to opt out of federal early innovator money designed to implement provisions of the ACA dictated from Washington.  As I have consistently said, healthcare policy for Kansas must be guided by the elected representatives of Kansans in the Legislature and in the Executive.  In this way, the wellbeing and protection of Kansans’ health, pocketbooks, and sovereignty will remain the top priority of any healthcare reform.”

Stop Obama Care in Kansas (SOCK), a coalition of 13 grassroots or conservative group leaders plus a 2nd District GOP delegate, have questioned the sincerity of Brownback’s opposition to the health care law. In a letter published August 9 they cite ongoing efforts to research and implement an exchange in Kansas and accuse Brownback of doing a “flip-flop” a-la Senator John Kerry on the issue.

The letter calls for Amanda Adkins to resign as chair of the Kansas Republican Party in part because of a conflict of interest between Cerner Corp. and the grass roots and GOP rank and file. Adkins managed Brownback’s 2004 Senate campaign before taking a job at Cerner in Kansas City, Missouri.

TheStreet.com, a financial news and services website, lists Cerner, a leader in health care information technology, as one of Obamacare’s biggest IT winners. Nancy Ann DeParle, a former member of Cerner’s board of directors, now serves as President Obama’s Deputy Chief of Staff for Policy. She was appointed director of the White House Office of Health Reform leading the administration’s efforts on health care issues, on the same day Sebelius was appointed secretary of HHS.

Richard Fry of November Patriots signed the letter calling on Adkins to resign. Fry said he thinks political deal making is behind efforts to set up an Obamacare exchange in Kansas. “I think one of the reasons for that is Brownback is connected to Cerner through his campaign manager who is also the chairperson for the KS GOP”

Fry said he did not have any specific indication of impropriety or conflict beyond the general affiliations.

“There is no conflict of interest,” Adkins said in a phone interview. “And I’ve been elected twice with not a single person running against me.“

Adkins said it’s important to understand the difference between a group sentiment and that of a few people. “I know most of the people who are commenting really don’t know what I do at Cerner and actually, most of the work I do is focused on people in private sector companies and families.“

Adkins said she is not authorized to speak about Cerner’s business dealings.

Fry, like a clear majority of those identifying with local tea party groups, said he believes Obamacare is unconstitutional and it is the duty of elected officials to oppose it because they’re sworn to uphold the Constitution. That includes not just sending back the $31.5 million grant but stopping all efforts to implement Obamacare.

SOCK is especially upset that Adkins wrote one of the resolutions coming before the GOP Committee meeting because it does not specifically demand that all work stop on implementing Obamacare, including any work on any exchange.

“Kansans don’t care about the source of the funds,” Fry said. “They care about the end results and they do not want an exchange. So, I just have concerns. We have reason to have concern because of the way the Governor and his administration has tried to cover up and spin what they’re actually doing.”

“It’s clearly deceptive and it’s a breach of their oath of office and a breach of their campaign promise.”

The letter, addressed to Adkins, says, “The SOCK coalition believes that the only prudent thing to do is to stop the design and development of the EIG ‘exchange’ in Kansas by Kansas and return the Early Innovator Grant funds to the HHS. We understand this may not in the best financial interest of your company the Cerner Corporation.”

The largest portion of the EIG was to be used to expand, complete and integrate the K-MED (Kansas Medical Eligibility Determination) system. A K-MED request for proposals from contractors was issued Oct. 9, 2010, more than two months before the EIG grant was applied for.

According to documents from the Kansas Insurance Department and a contractor working on the project, K-MED is a distinct medical information technology system linking existing state medical and data services that would provide infrastructure for the exchange if the U.S. Supreme Court rules Obamacare is constitutional.

With or without Obamacare, K-MED would still be available to support Medicaid enrollment and reduce fraud.

Insert image of May 3 presentation by Gary Schneider of STS Consulting, a contractor on the project, indicates K-Med and the exchange are two overlapping projects as one coordinated effort.

Beverly Gossage, a healthcare consultant, is a member of three exchange working groups studying how to set up an exchange for Kansas. She said the complexity of Obamacare and what exactly an exchange is has led to some of the confusion.

Gossage opposes Obamacare and setting up any government healthcare exchange in Kansas but commends Brownback and Lt. Governor Jeff Colyer for returning the EIG.

In a statement emailed to KansasWatchdog, Gossage said, “It became clear as we studied exchanges that a government exchange would raise the rates considerably for most Kansans, would destroy the free market for health insurance, would expand overcrowded Medicaid rolls, and lead to unfunded subsidies to 65 percent of Kansans.”

Gossage told KansasWatchdog that Brownback’s administration and legislators are still learning about a very complex topic and she suggests activists exercise patience and work within the process.

“Keep in mind that Kansas cannot set up an exchange without the legislature sending an exchange bill to the Governor, and he would have to sign it. I believe we have enough common-sense legislators who will refuse to vote for such a bill, decreasing the likelihood that one would ever reach his desk. Plus, the Governor has stated that he will not implement Obamacare in Kansas. We need to let our legislators know that we do not want a government run exchange.”

The legislative process has also hit some bumps.

Rep. Charlotte O’Hara, R-Overland Park, is an outspoken critic of the state legislature’s acceptance of federal dollars and the attached strings that control the government and citizens of Kansas. “I am convinced that change in our state and nation will not and really cannot come from inside, too much business as usual attitude.”

According to emails O’Hara posted on her Facebook page, she asked House Speaker Mike O’Neal to appoint her to the joint Financial Institutions and Insurance Interim Committee that will, “Review options for a Kansas health insurance exchange that will comply with the federal health care legislation.”

In the emails O’Neal expressed reservations, agreed to the appointment then rescinded after additional public comments by O’Hara.

As I mentioned in my first e-mail response to you when you asked to be considered for the Committee, I have been concerned with your rhetoric on this subject. I do respect your views but your manner of articulating those views has been concerning to me and now with the latest pod-cast I found several of your remarks did not reflect the “respectful and healthy attitude” I am looking for in a Committee member. You are absolutely entitled to your views and I believe in your right to say exactly what you feel, but as an elected official and fellow House member, your rhetoric reflects on me and the House, whether those remarks are made in the committee setting or otherwise. A number of colleagues, many of whom agree with you philosophically on the subject, have already expressed concern and disappointment over the tone of your remarks during the pod-cast. The Committee has a stated function and being a platform for the strident advocacy of a singular view by any Committee member is not that function. The Committee may well reach a result consistent with your view but it needs to be because it was the product of consensus reached after open-minded consideration of the relevant facts, consensus which you have previously expressed some disdain for.”

The podcast in question is a July 12 broadcast of Kansas Secretary of State Kris Kobach interviewing O’Hara. During the interview made numerous requests for listeners to call Lt. Governor Colyer and tell him to give the EIG money back.

Politicians in Washington and Kansas are struggling with the growing power and influence of conservative grass roots movements. The rapid shift in power is causing problems for old and new power brokers.

“Just like in Washington, some political players in Kansas have characterized tea party activists and those who they helped elect as lacking in understanding, unwilling to compromise, even extremist,” said O’Hara.

“I believe that research needs to be done to make sure that the projects marked for use of the Early Innovator Grants are not being funded by an alternative source,” O’Hara said in an email to KansasWatchdog.

She also said Adkins’ role at Cerner and Cerner’s benefit from Obamacare needs to be watched. “Conflict of interest at times can be a narrow plank to walk.”

“Activists have the right to question the actions of those in public office. If the grassroots hadn’t put pressure on the Brownback Administration to return the Early Innovator Grant, would they have returned the grant?

Pilcher-Cook agrees with the tea party activists’ aims in stopping Obamacare but she also praises efforts by the legislature and Brownback to work within the system and political realities.

She stressed that the political process requires a majority vote by the House and Senate and urged activists to, “Focus on the political process, learn it and work within it.”

“The state has been controlled by the left wing for many years. There’s a culture to change, but it’s not going to happen overnight,” Pilcher-Cook said. “That’s where the tea party needs to put their energy, into the Senate members who vote for legislation that meets their approval.”

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Related

Insurance Department: Return of $31.5M grant makes Kansas-run exchange less likely (bizjournals.com)

New Kansas health insurance mart meets skepticism (kansasreporter.org)