by Denis Knight, DO
One recent weekend I spent time with my wife, Ginna, at one of our excellent community hospitals as she recovered from major surgery. It gave me time to reflect on the hours I have spent at this institution through the years treating patients.
I found that I was lingering at the photos on the wall explaining the history of this distinguished institution and the progress made in delivering care to the citizens of Sedgwick County. I no longer admit to hospitals as a family physician, having turned over the responsibility to hospitalists far more skillful than I in treating acutely ill patients, but I wholeheartedly support their valuable role in serving our patients and the community.
When I began practicing medicine in 1988, many retired doctors told me I had missed the “golden age of medicine” in America and reminisced about how we had a county hospital for the poor and private hospitals for those who could pay for services. They also exclaimed that the 1965 creation of Medicare and Medicaid during the Johnson Administration clearly improved hospitals’ breadth and scope of services for treating the elderly and the poor, as well as improving the training of young resident physicians. Predating this, the Hill-Burton Act of 1946 provided capital to hospitals in exchange for them making care available to low income and uninsured patients, sometimes for 25 years and sometimes in perpetuity.
This history lesson brings me to the pragmatism and leadership of a conservative president by the name of Ronald Reagan, who in 1986 signed the Consolidated Omnibus Budget Reconciliation Act. COBRA came as some hospitals were aging out of their Hill-Burton obligations and care for uninsured patients was becoming more uncertain. The budget package included the Emergency Medical Treatment and Active Labor Act, a law preventing one hospital emergency department from dumping undesirable patients on another because of their condition or inability to pay. Since I trained during the years predating EMTALA and worked in an ER, I saw this dumping firsthand. The law is considered the largest unfunded mandate in the history of the federal government but leads to my point: Even a conservative president of the United States who had been a conservative governor of California recognized that our society had an obligation to help treat the working poor and disadvantaged. He would not have signed this bill into law unless he felt that these citizens were entitled to the same quality of health care as those with the ability to pay.
The community hospitals in Sedgwick County and throughout Kansas are obliged to treat all persons who come to their emergency departments and the obligation extends to acute care hospitalization until patients are stabilized for transfer or dismissal. These hospitals and the dedicated physicians laboring in them would be aided by expansion of KanCare to the more than 150,000 working Kansans who do not currently qualify for Medicaid and who cannot afford to purchase health care insurance.
The position of the Medical Society of Sedgwick County and the Kansas Medical Society has long been that we support KanCare expansion if done in a “fiscally responsible manner.” The Kansas Hospital Association has likewise supported expansion and believes that the expansion can be “budget neutral.” Recently, the Kansas Legislature presented an expansion bill to our governor that he immediately vetoed, falling two votes short in the Senate and three in the House of the numbers necessary to override the veto. Meanwhile, from Washington, we are told by House Speaker Paul Ryan that, with the failure to repeal and replace Obamacare, the Affordable Care Act is here for the foreseeable future.
With the Kansas vote and Speaker Ryan’s statement in mind, we as physicians should be unceasing in our advocacy to improve Kansans’ access to affordable health care and in support of the community hospitals seeking to treat them. We also should continue to support such programs as Project Access, Medical Service Bureau and Health ICT. We should recognize and support the so-called “safety net” that serves the KanCare and uninsured population, including the Sedgwick County Division of Health, the KU School of Medicine and in particular the JayDoc program, Guadalupe Clinic, Hunter Health, Mayflower Clinic, GraceMed, the Center for Health and Wellness and many others. In addition, I believe we should encourage all physicians that see “self pay,” Medicare and Medicaid patients to continue to do so, in spite of increasing contractual adjustments.
I have considered myself a conservative both fiscally and socially throughout my life, but I believe that our governor and our Legislature need to do what most Kansans agree is the right thing: Expand KanCare and access to health care.