By Mike Shields
KHI News Service

Marcia Nielsen, executive director of the Kansas Health Policy Authority, described the agency's 21-point health reform plan to members of the Joint Health Policy Oversight Committee on Thursday. Nielsen strongly urged lawmakers to enact a tobacco tax increase and statewide public smoking ban. (Thad Allton/KHI)

TOPEKA, Nov. 5 - A 21-point health reform plan months in the making is now in the hands of Kansas lawmakers.

Delivered last week, it was a wide ranging blueprint that designers said was best taken as a whole, not piecemeal.  What happens with it now is expected to be one of the defining issues of the 2008 Legislature.

As Kim Moore, president of United Methodist Health Ministry Fund, said, depending upon the Legislature's response it " - Can be a milestone in health reform -or-just another bump in the long road of missed opportunities."

The plan was meant to be one that could win the backing of a majority of the state's 165 legislators in a year when all Senate and House seats are up for election.  Some reform ideas strongly supported by the Kansas Health Policy Authority board as it built the plan were tossed aside after legislators on an advisory committee insisted mandates or broad expansions of existing public programs would make the reform package politically untenable.

"First, big step"

But even with those sacrifices to expediency some pillars of the plan, most notably the calls for a 50 cent-per-pack tobacco tax increase and a statewide smoking ban, face certain resistance.

Even as the plan was unveiled, some said that if half its goals were approved, significant progress would have been achieved.  Everyone from the governor to the House speaker called it an early step.

"This is a first, big step" toward "making a dent" in the "unsustainable cost of health care," Marcia Nielsen, executive director of the health policy authority, told committee members.

"Although KHPA's proposal will not insure all Kansans, it is a strong step to help more Kansans access health insurance. I support the KHPA focus on transforming the system, so that we lower costs and spend money on prevention and disease management," Gov. Kathleen Sebelius, a Democrat, said. "This is an incremental approach to full coverage for all Kansans."

The plan's genesis was in January, when Sebelius in her annual message to legislators called for a plan for "universal" coverage in a state where about 300,000 people are thought to be medically uninsured.

By April, legislators had given the health policy authority instructions for delivery of a more detailed but less expansive plan for them to act on.

The health policy authority's plan is based on a concept they call "the three P's." Click here for more information. (Cathy McNorton/KHI)

The result is a diverse array of interlocking recommendations designed, if wholly enacted, to provide health insurance to about 86,000 more Kansans , including 20,000 children. The plan also encourages healthier living. The plan's designers grouped their recommendations under three main headings they called "The Three Ps": Prevention, Personal responsibility, and Protection of affordable insurance. Notably absent from the plan is a mandate requiring anyone to have insurance. The plan's authors had earlier endorsed the idea of requiring that all Kansas children ages 18 and under have health insurance. And some other states, Massachusetts is the most prominent example, have adopted mandates requiring individuals or employers or both to buy health insurance.

Some were disappointed that the children's mandate was omitted but Jerry Slaughter, director of the Kansas Medical Society, said the absence of coverage mandates from the plan was a strength.

 "If we even achieve half that, that's pretty darn good," Slaughter told legislators. "That's 43,000 people (covered) without mandates or pushing people away from the table. If we could do nothing more than reduce the incidence of smoking that would have big consequences in the years ahead. We believe the health policy authority has done what you've asked of them."

Tobacco tax

The agency was publicly praised by House Speaker Melvin Neufeld, R-Ingalls, for crafting a politically realistic plan even as his spokesperson admitted to reporters that it was very unlikely Neufeld would vote for the increased cigarette tax that would help pay for the plan, which is expected to cost about $160 million, including federal support, after reaching full implementation in four years.

Nielsen's strongest urging to the oversight committee was on behalf of the cigarette tax and ban. The plan would add 50 cents per pack to the current 79-cent state tax on cigarettes, generating about $52 million a year for the state treasury.

"If, in fact, you're interested in promoting health," Nielsen told lawmakers. "This has got to be included. It is one of the most critical priorities."

She described a bigger tobacco tax as a "health policy three-fer":
· One, it would help cut the estimated $937 million a year in health care costs associated with tobacco use.
· Two, it would provide money to fund the other health initiatives.
· Three, the tax would discourage some people from smoking and encourage others to quit or smoke less.

The Legislature has recently rejected calls to increase the tobacco tax and last session passed over a bill creating a statewide smoking ban. But there was evidence after Nielsen's presentation that legislators might now be more willing to adopt reforms previously rejected or tabled, including those dealing with improved school nutrition and physical education.

"PE needs to be brought into the curriculum," said Rep. Bob Bethell, R-Alden.

And when it comes to getting rid of vending machine junk food in schools -   "It's imperative to get that going right away," said Rep. Bill Feuerborn, D-Garnett.

Bethell said even the tobacco tax might fare better than many have predicted.

"Twenty percent of Kansas residents are smokers. That obviously gives you 80 percent that aren't," he said. "Many voters will probably say it won't bother me - but the other 20 percent will be pretty vocal about it. And I think, too, you've got to look at the 20 percent who are smokers and where they fall in the socio-economic strata. All the data I've seen shows they are low-income, so it may be seen as a regressive tax and not go anywhere. Then again, 80 percent may be enough to say (the tax increase) goes through."