IN THIS ISSUE:

Facts about premium assistance for health insurance

Immigration study requested of post audit

New energy package introduced

Kansas ranked 20th on national health care scorecard

New program to expand opportunities for seniors and disabled Kansans

SRS announces $8.9 million in grants to local communities

Kansas local government statewide housing program

Planning for new transportation program must begin now

In committees next week

FACTS ABOUT PREMIUM ASSISTANCE FOR HEALTH INSURANCE

The Kansas Health Policy authority has produced a fact sheet about "Kansas Healthy Choices," a new health insurance program that provides private health insurance to low-income Kansas families.  In Kansas, children in families who earn up to 200 percent of the federal poverty level (FPL) are eligible for insurance through Medicaid or Healthwave.  However, Kansas currently has one of the lowest rates of Medicaid eligibility in the nation.

Premium assistance uses employer assistance, individual contributions and public funding, to purchase private health insurance for Kansas families living in poverty who cannot afford coverage.  "Kansas Healthy Choices" (KHC) provides premium assistance to access a range of private health insurance options for eligible families.

The program applies restrictions on families' purchase of private insurance, while offering:

• State access to 60 percent federal matching funds
• Cost-effectiveness as compared to both private insurance and Medicaid
• Access to affordable healthcare for families living in poverty
• Protection of benefits to those currently eligible for Healthwave
• Coverage for newly eligible parents on a par with private insurance plans
• Coverage under one plan for each member of the family
• Continuing access to a primary care medical home

Insurance options under Kansas Healthy Choices:

Families eligible for Kansas Healthy Choices will receive private coverage through one of the following mechanisms subject to Federal approvals:

• Employer sponsored insurance (ESI) buy-in: For families with access to employer sponsored private health insurance, the state would pay the employee share of the health insurance premium for families.
• Competitively bid state-procured health plans: For families without access to a qualifying employer plan, KHPA will provide a choice of three state negotiated and procured health plans offering high quality, cost effective benefits. Basic benefits will be tied to the value of state employee benefits.
• Health opportunity account (HOA) pilot: Families in two counties will have access to a pilot program testing the application of consumer-driven purchasing in a low-income population. A high-deductible health plan is coupled with a funded health opportunity account to provide incentives for prudent, prevention-oriented health care choices.

Participation in Kansas Healthy Choices: 

KHC options begin in January 2009. Over three years, the program is expected to provide approximately 20,000 existing and 24,500 newly eligible caretaker adults and their children with the choice of private insurance options and a "medical home" model of health care services.

IMMIGRATION STUDY REQUESTED OF POST AUDIT

By now, there is little need to recount the failure of the Federal Government to control illegal immigration into our work force.  States across the country have been forced to deal with the effects of undocumented workers and the attendant political, social and economic issues.

Kansas is of course no exception to this rule.  There is growing uncertainty in our constituents as to the impact this population has on our economy.  Although there have been studies by other states, and academic and policy groups, the Kansas legislature does not have a base line understanding of the impact illegal immigration has had and what might be the consequences of various policy initiatives.

I have made a formal request of the Post Audit Committee to authorize the department to conduct an analysis of the economic impact of illegal immigration on the State of Kansas.  This study would include but not necessarily be limited to analysis of:

• Amount of taxes paid to the State of Kansas
• Cost of social services to the State of Kansas
• Impact of illegal immigration on labor costs and jobs filled
• Economic impact of pending or proposed legislation

I believe that we as a legislature must have objective and Kansas specific data as we debate these issues.  The risk of unintended consequences increases as we endeavor to address complex issues without such factual testimony.

FIRST ENERGY BILL OF THE SESSION INTRODUCED

In October 2006, Kansas Department of Health and Environment rejected the expansion of two, 700-megawatt coal-fired power plants near Holcomb, Kansas.  The Secretary cited concerns about carbon dioxide emissions and global warming in his reasoning. Governor Kathleen Sebelius has supported the permit denial.  Since then, the plant developers, Sunflower Electric Power Corporation and their legislative supporters, mounted an effort to reverse the decision. 

Supporters of the expansion say the units will rank among the cleanest coal-burning plants in the nation and provide an economic boost to western Kansas.  Opponents decry the environmental and health effects from 11 million tons of annual carbon dioxide emissions, while 85 percent of the energy produced by the plants will be sold to out-of-state customers. 

For months, it has been a highly anticipated topic of the 2008 legislative session and the first bill was introduced to both the House and Senate this week.

Here is an overview of what was presented: 

The bill would impose Kansas' first limits on carbon dioxide emissions.  However, it would also include provisions to Kansas law that would offer the two coal-fired power plants a second opportunity to receive necessary permits by investing in environmental technology.  Additionally, the bill would change rules governing the approval of those permits.  

The CO2 standards would apply to new electric generating plants and would make Kansas among a growing number of states attempting to reduce CO2 emissions.  Global warming has been linked by scientists to greenhouse gas emissions.

Kansas legislators who support the bill said it proposes what would be the first state law to tackle emissions by utilities. The CO2 standards would apply to new plants- no matter what fuel they burned. 

Additional features of the bill include:

• Setting energy efficiency standards for new state and public school buildings and state vehicles
• Requiring utilities to allow customers to reduce their bills by using solar power (net metering)
• Establishing a new commission to study issues surrounding electric generation
• Revoking the authority of the Kansas Department of Health and Environment to impose emissions standards more stringent than those imposed by the federal Clean Air Act without legislative approval

Opponents continue to be skeptical that this bill will provide sufficient environmental protection to justify building the Holcomb plant.  These individuals insist that the best solution to Kansas' energy needs will be found in increased development of renewable energy initiatives such as ethanol and wind.

This is only the beginning of what promises to be a long, political debate. 

I support the advancement of renewable energy development in Kansas and I will consider all opportunities to meet base load energy needs of Kansans.  I do not support the bulk of the bill in its current form.  However, I am confident that many changes will be incorporated and I will monitor this issue closely and keep you informed.

KANSAS RANKED 20^TH ON NATIONAL HEALTH CARE SCORECARD

The Commonwealth Fund (a nonprofit organization devoted to improving health care access, quality and efficiency) recently released a state-by-state comparison of key health-care components.  Kansas ranked #20 on the list. 

The study concluded that geographic location creates dramatic variations in care and system performance.  Some suggest the wide gap revealed a strong need for universal health coverage.  Others said it showed a greater need for states to learn from each other. 

"If all the states could do as well as the top states, 90,000 lives could be saved annually, 22 million more adults and children would have health insurance and millions of older adults, diabetics and young children would receive essential preventive care," said Karen Davis, president of the Commonwealth Fund, who sponsored the report. 

In most of the 32 indicators compared in the report, Kansas ranked somewhere in the middle.  However, had it matched the top performing states, according to Commonwealth statistics:

• There could have been 520 fewer premature deaths
• 62,055 more adults and 11,237 more children here would have health insurance
• 29,576 more diabetics that are adult would have received recommended services
• Almost $90 million would have been saved from the elimination of unnecessary hospitalizations.

Kansas earned its best ranking, 10th in the nation, for the relatively low number of uninsured children.  It ranked near the bottom for percentage of heart patients given written instructions when discharged from the hospital.  It also ranked poorly, 36th, for its relatively high number of deaths from breast cancer. 

Additionally, the report indicated ethnic disparities in Kansas, noting a significantly higher incidence of deaths among blacks that might have been avoided with proper health care.  Citing 2002 data, the report ranked Kansas 21st for its incidence of white deaths amenable to health care, but 32nd for its black deaths amenable to health care.  A variety of earlier studies by the Kansas Health Institute also revealed health care disparities for Kansas minorities.

Robert St. Peter, president of the Kansas Health Institute, said the Commonwealth findings were important because "they show the clear connection between access and quality. They also show that it doesn't necessarily cost more to have a high performing system." 

The Commonwealth report came just two days after the Federal Agency for Healthcare Research and Quality released its state rankings on health care quality.  That federal report used 129 indicators versus the Commonwealth's 32.  Each ranked Kansas somewhere in the middle.

"It demonstrates that Kansas has its areas that need improvement," said Marcia Nielsen, executive director of the Kansas Health Policy Authority, which is expected to develop its own performance measurements. "We intend to study the results of these scorecards and rankings carefully."

As legislators continue to examine health care reform this session, studies such as the Commonwealth scorecard provide legislators with helpful, objective information about Kansas' strengths and weaknesses.  Examples from other states will certainly be part of the discussion and stimulate ideas for reform. 

NEW PROGRAM TO EXPAND OPPORTUNITIES FOR SENIORS AND DISABLED

Last summer, three state agencies - Kansas Health Policy Authority, Department on Aging, Department of Social and Rehabilitation Services - began participating in the "Money Follows the Person" initiative.  This federal program aims at promoting community-based care.

Many seniors and disabled individuals resent forced transitions to institutional settings such as a nursing homes, group homes or state hospitals.  Unfortunately, this becomes the primary care solution because too many family members and consumers are not aware of alternatives.  "Money Follows the Person" aims to remedy this problem.  Over the next four years, SRS and the Kansas Department on Aging will move 934 people- all on Medicaid- out of institutional care and back into the community.  Medicaid will fund consumers' cost of living in the community just as it covered cost of nursing home care, only for much less. 

The program has been tested in Kansas.  In recent years, Medicaid helped fund moves of people out of institutional settings and into settings covered by the state's home and community based services waiver.  However, no more than 80 people per year received this service and the federal government funded 60 percent of the cost. 

Beginning July 2009, federal assistance will increase to 80 percent.  Over the next four years, Kansas anticipates that federal contributions and decreased costs (because institutional care is extremely expensive) will save the state $37 million.

Cutting costs of the state budget always ranks as a high priority for legislators.  State Medicaid spending has been one of the fastest growing portions of the state budget in recent years, so curbing the program's costs are both helpful and necessary. Last year, the average Medicaid-funded stay in a nursing home cost approximately $2,400 a month; the average "frail elderly" stay in a community setting cost approximately $825 a month. This program is a reasonable step forward that also increases options for consumers.

In Kansas, government spending on community-based programs has long lagged behind that for nursing homes because Medicaid-funded nursing home stays are considered an entitlement, while home-based care is not.  That means the nursing home caseload for Medicaid is automatically built into each year's budget, joining other non-discretionary spending categories. 

Moves to community settings, on the other hand, are limited to how much leftover or "discretionary," money legislators have available and are willing to spend.  The disparity is compounded by Medicaid payments to nursing homes indexed to inflation, while payments to community-based programs are not.

An AARP survey in 2006 found Kansas had 68 nursing home beds for every 1,000 people over age 65. Only five states surpassed this, with the national average at 47 beds per 1,000.  The survey also found that for every 100 Kansas residents over age 65, 5.8 lived in a nursing home. Only three states had a higher rate, with a national average at four.  AARP updates the survey every two years.

In Kansas, no one knows definitively the number of consumers living in institutional settings who, with help, could live on their own.  Of the 934 people expected to move out of institutional settings by 2011:

• 286 are developmentally disabled adults now in a state hospital or large group home
• 242 are seniors and living in nursing homes
• 406 are physically disabled or brain-injured and living in nursing homes

Data from the Department on Aging reveal that approximately 500 of the state's 10,500 nursing home residents on Medicaid are under age 55.  More than 3,000 nursing home residents indicate they would prefer to live in a community setting (though it is unclear how many of those residents could be moved or how many are recovering from hospitalizations and would be returning home anyway).

Advocates for seniors and physically disabled said they hope "Money Follows the Person" will level the playing field between community and institutional settings.  State policies, they say, have long favored institutional care, noting that almost 70 percent of the state's long-term care budget is spent on nursing homes, while only 30 percent goes to community-based programs. 

In fiscal year 2008, Kansas expects to spend $352.5 million on nursing home care for 10,605 people. It will spend $170.9 million for the 11,973 seniors or physically disabled persons living in community settings.

Most importantly, "Money Follows the Person" hopes to increase opportunities for seniors and disabled Kansans.  Institutional care will still remain the best option for a number of consumers and receive support from the state.  However, everyone deserves the right to choose where they want to receive necessary services.  As lawmakers, if we have an opportunity to offer that choice, we have a responsibility make it available.

GRANT FUNDS AIMED AT REDUCING UNDERAGE DRINKING

The Kansas Department of Social and Rehabilitation Services recently awarded Strategic Prevention Framework (SPF) Grants to fourteen Kansas community partnerships to support efforts to prevent and reduce underage drinking.

Grants were awarded to the following community partnerships:

• Clay Counts - Clay County
• Drug Free Osage County - Osage County
• Finney County Community Health Coalition - Finney County
• Harper County ICC - Harper County
• Kingman County Substance Abuse Prevention Group - Kingman County
• Liberal Area Coalition for Families - Seward County
• Linn County Children's Coalition - Linn County
• Quality of Life Coalition, Inc. - Dickinson County
• Reno County Communities That Care Coalition - Reno County
• Russell County Community Partnership - Russell County
• Safe Streets Coalition - Shawnee County
• Sumner County Community Drug Action Team - Sumner County
• United 4 Youth - Nemaha County
• Woodson County Interagency Coalition - Woodson County

"These grants allow the state to partner with local communities to achieve a shared goal of reducing underage drinking by building a solid foundation for service delivery that will benefit not only the current generation, but also future generations of Kansans, " said SRS Secretary Don Jordan.

Planning grant awards totaling approximately $600,000 will support a nine-month planning process to develop community-based strategies to affect underage drinking.  Additional funds totaling approximately $8.3 million will be available to support implementation of approved community plans over the next three years. 

The Kansas SPF is intended to reduce underage drinking in target communities and enrich prevention efforts across the state through the implementation and sustainability of effective, culturally competent prevention strategies.

The Strategic Prevention Framework Grant is funded through the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Prevention (CSAP).  SRS is administering the grant process on behalf of the Governor's Office.

KANSAS LOCAL GOVERNMENT STATEWIDE HOUSING PROGRAM

Over 3100 families living in 71 Kansas counties became first-time homeowners in 2007 thanks to the Kansas Local Government Statewide Housing Program.  This program provided low and moderate-income Kansas families with nearly $281 million in mortgage financing through safe, 30-year fixed rate mortgages and down payment assistance. 

Additionally, up to $3 million has been reserved for existing homeowners and residents of Greensburg and Southeast Kansas to rebuild homes damaged by 2007 natural disasters.  Currently, 334 cities in 103 counties participate in the program. The program is open to any qualified mortgage lender. 

Fifty-one lenders working from 195 neighborhood branch offices make this one of the most accessible homebuyer programs in Kansas.

PLANNING FOR NEW TRANSPORTATION PROGRAM MUST BEGIN NOW

State and national highway officials said this week that policymakers must explore new methods of funding transportation projects in Kansas.  Lawmakers of the House and Senate Transportation and Tax Committees received information regarding the inability of America's infrastructure to handle the volume of people and goods it carries each day.

A number of factors reduce the purchasing power of transportation dollars, including more fuel-efficient vehicles, inflation and public opposition to increased fuel tax.  Officials warned that the nation's infrastructure is in dire need of repairs and expansion.  "There is no question that as a nation, we are going to have to find and invest more public dollars in our infrastructure," said Janet Kavinoky, director of transportation infrastructure with the U.S. Chamber of Commerce.

Michael Meyer, with the Georgia Institute of Technology, said states across the nation are searching for alternative supplements to the fuel tax.  Possibilities include additional toll roads, inflation-indexed fuel taxes, more public-private partnerships to build roads and mileage-based fees (such as a pilot project in Oregon that measures how much drivers travel and charges them accordingly).

Developing a comprehensive transportation program for Kansas is tremendously important.  The new plan will require innovative thinking and difficult prioritizing.  A failure to adequately prepare for the future will leave our infrastructure overworked, under-funded and increasingly unsafe.  Though time still remains on the current program, development for the next phase must begin now.

As planning gets underway, communities must voice their desire for highway projects so they will be included in the next cycle.  The last program, passed in 1999, provided over $13.6 billion in infrastructure improvements.  This included funding for short line railroads, airports and public transit systems.  The program also provided over 114,000 jobs.

IN COMMITTEES NEXT WEEK:

House Agriculture and Natural Resources: Hearings on HB 2660, concerning payment of petroleum products and inspection fees; Hearings on SB 267, concerning failure to comply with a Wildlife and Parks Citation.

House Commerce & Labor: Hearings on HB 2497, which addresses investment and divestment standards for the board of trustees of the Kansas Public Employees Retirement System; Hearings on HB 2315, which addresses home inspectors' competency and financial responsibility.

House Economic Development and Tourism: Hearings on SB 363, concerning rural housing incentives; Hearings on HB 2603, allowing qualification for certain business tax credits through other members of a unitary group.

House Education: Hearings on HB 2608, which addresses school finance in relation to enrollment after a disaster.

House Elections and Governmental Organization: Hearings on 2697, concerning campaign finance and reporting name of employer of certain individual contributions; Hearings on SB 196, establishing requirements for reporting of independent expenditures and certain campaign contributions; Hearings on HB 2408 concerning campaign finance reporting requirements.

House Energy and Utilities: Hearings on HB 2711, which explore electric generation, transmission and efficiency and air emissions proponents.

House Federal & State Affairs: Hearings on HB 2616, which is an act concerning the inspection and regulation of amusement rides.

House Government Efficiency and Technology: Hearings on HB 2647 regarding the taxpayer transparency act.

House Health and Human Services: Hearings on HB 2672, concerning the Department on Aging, relating to long-term care units; Hearings on HB 2570, concerning adoptions.

House Insurance and Financial Institutions: Hearings on HB 2688 addressing enacting the property and casualty actuarial opinion letter law; Hearings on HB 2689 concerning risk-based capital requirements for insurance; Hearings on HB 2690 concerning life insurance and accrual of interest and dividends during deferment periods.

House Judiciary: Hearings on HB 2656 authorizing cemetery corporations to convey real estate not platted into cemetery lots free from trust restrictions; Hearings on HB 2620 concerning non-disciplinary resolutions of the State Board of Healing Arts; Hearings on HB 2701 regarding laboratory fees for criminal procedures; Hearings on HB 2674 creating the crime of negligent homicide; Hearings on HB 2684 concerning felony criminal desecration of human remains.

House Taxation: Hearings on HB 2520, which address liability for taxes and other expenses related to conversion of lands into condominiums.

House Transportation: Hearings on HB 2665, concerning destruction of surrendered driver's licenses; Hearings on HB 2659, designating a portion of U.S. 400 Highway as the Atomic Veteran's Memorial Highway.

Please feel free to let me know if you would like any further information on these bills, or would like to testify before a committee on an issue important to you.