TOPEKA — Lt. Governor Jeff Colyer spent nearly two hours with the Legislature’s Joint Committee on Health Policy Oversight Monday explaining the imperative and complexity of solving problems with government health care he likened to a Rubik’s Cube.

The challenge of the 1974 puzzle and the current Medicaid and health care debate is finding a way to align multiple facets of each side without upsetting another side.

Recent moves by Gov. Sam Brownback’s administration aimed at dealing with the Patient Protection and Affordable Care Act, popularly known as ObamaCare, and reducing Medicaid costs have upset tea party activists whose staunch opposition to ObamaCare and Medicaid have become Kansas Republican Party policy.

Likely cuts and other changes to Medicaid and opposition to ObamaCare have upset citizens who rely on those programs and the politicians who represent them.

The committee and an overflow crowd of spectators heard differing views about the future of a government health insurance exchange in Kansas from Colyer and Insurance Commissioner Sandy Praeger. While they agreed that growing and uncertain federal regulation related to ObamaCare make it difficult to move forward, they differed sharply on the appropriate course of action.

At the beginning of Colyer’s remarks he repeated the Brownback administration’s policy against establishing a health care exchange in Kansas. “We are not building an exchange or implementing an exchange until the (U.S.) Supreme Court has made its ruling.”

Kansas is one of 26 states participating in a suit challenging the constitutionality of ObamaCare. Several other challenges to the law are also working their way through the court system. Legal analysts expect the U.S. Supreme Court will combine some or all of the cases and make a ruling but the timing is uncertain.

Colyer said the Brownback administration’s recent decisions regarding health care give the state maximum flexibility and the legislature its opportunity to make decisions in anticipation of the Supreme Court ruling.

On August 9 Brownback opted out of a $31.5 million federal Early Innovator Grant intended to build the Kansas Medicaid Eligibility Determination (KMED) project that would serve as the backbone of the state’s Obamacare exchange.

On August 30 Brownback announced the state had contracted with Accenture, an international consulting firm, to build KEES, the Kansas Eligibility Enforcement System, to integrate the state’s resources used for health care enrollment and administration.

The differences between Colyer’s vision and Praeger’s efforts, as well as some of the points of agreement, illustrate the complex challenge of reforming health care while maintaining public and political support.

Central to that challenge is formation of an improved health information technology system that Colyer and other Brownback appointees say can integrate state systems to reduce fraud but that Praeger said is the core of an ObamaCare exchange designed for Kansas priorities.

Praeger outlined her department’s efforts to prepare for implementation of an ObamaCare exchange in Kansas but said an exchange could not be implemented without approval from the Legislature.

She presented charts showing progress on building information technology components of the Kansas Health Insurance Exchange Project. A draft chart dated Sept. 12, 2011, showed components of the proposed KEES system that matched item for item with requirements for a federal exchange for provision of a web portal, account management, security, authentication, eligibility and cost sharing. The chart also showed that KEES is not providing required exchange components for an individual or employer marketplace or plan management.

Democrat committee members asked mostly supportive questions of Praeger and challenged Colyer. Republican members tended to support Colyer but also referenced points of tea party opposition to Brownback’s plans.

A notable exception to Republican comportment was a direct disagreement between Colyer and Sen. Roger Reitz, R-Manhattan. Reitz, a physician, said, “You can’t do medicine without money and big bucks will have to be there. And the fact that you’re talking all through this about how you’re going to do it without money, with cuts, well then, let’s do something about the cuts. Let’s stop doing them and start paying for what we’re doing.”

Colyer had earlier pointed out that Kansas has a lot of challenges including unemployment, funding public education, underfunded public pensions, large budget deficits – even with the 2010 tax increase, large cuts in federal spending and Medicaid, which Colyer called a “huge program that needs to be reconciled with the modern world.”

Growing Medicaid enrollment, more expensive procedures and calls for cuts in federal spending for Medicaid that are certain to get deeper mean Kansas must act quickly or be overwhelmed, Colyer said. Although some states have chosen to cut Medicaid spending to meet budget challenges, Colyer said he and Governor Sam Brownback believe the best way to keep Medicaid available for citizens who need it is to transform how it works in Kansas.

Kansas should expect at least a $72 million cut in federal Medicaid support in the next few years that will steepen the rise in Medicaid costs to the state, Colyer said.

“This is the most complex thing I’ve seen in government, and we ain’t going to fix it in one year. But we’re going to make giant strides this year and we want to keep working with you in the future for multiple years. And we’re going to experiment some. Some things are going to work very well and some aren’t. And there are lots of ideas and we can’t do them all at once.”

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Related:

Kansas Republican Committee Welcomes and Supports Tea Party Agenda (kansaswatchdog.org)

Kansas Inks $135 Million Contract for Medicaid Screening (kansaswatchdog.org)

Governor Seeking Federal Grant for Key Component of ‘Obamacare’ Exchange (kansaswatchdog.org)

Lt. Gov. Colyer: Health Care Early Innovator Grant was ‘Baby Elephant’ (kansaswatchdog.org)