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Kansas United Methodist Health Philanthropy in Action
2015 Annual Report

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Can Anything Be Done?

Kim Moore
In 2015, the health care conglomerate in America achieved a new level of economic attainment: 18% of the gross domestic product, even though growth has been holding steady in recent years ahead of 2014. The average family health insurance premium in Kansas was reported to be $15,652. One mid-sized community hospital closed in Kansas - Mercy in Independence. iVantage (a national health care consulting firm) identified 31 hospitals in Kansas which are vulnerable to closing. Kansas continued to refuse to expand Medicaid, leaving about 150,000 Kansans with negligible financial access to healthcare. Congress voted to repeal the Affordable Care Act and that repealer was vetoed by the President. There was not any meaningful proposal for a replacement. There was little good on the health care front in Kansas or America in 2015.

Can anything be done about it - with "it" being a health care system with sky-high, uncontrollable costs; a quality which is mediocre and variable; and thousands of Kansans (and millions of Americans) still without financial access to care when they need it? We can support a KanCare expansion to bring 4-5% more Kansans into financial access to care and assist struggling providers. We can develop new models for Kansas rural health systems to consider in remaking themselves to save vital health care for their regions. We can help communities plan for their health care needs, focusing on what are essential health care services to support a quality of life in their areas. We can support navigators to assist consumers seeking health insurance through the federal insurance marketplace which provided 101,555 Kansans affordable coverage in 2015. The Health Ministry utilized all these strategies in 2015 and into 2016 with some success or at least promising beginnings.

We are trapped between competing ideologies in the struggle to remake health care in Kansas and in America. On one hand, there are libertarian, anti-government leaders who believe government cannot do anything right so government's role as a payor of last resort and regulator of the industry should be minimized or ended. This group believes that a free market led primarily by consumers can solve the health care mess. To them, government is the problem. The other side believes there is a market failure which has created the health care mess and that government is the only instrument with sufficient resources and scale to handle, or at least referee, the burgeoning access, cost and quality problems. This group has adopted, through the Affordable Care Act and Medicare reforms, a primary strategy that payors - Medicare with its gargantuan influence and private insurers if placed in head to head competition - can be the vehicles for change.

The heated debate created by this divide leads to simplistic, single cause answers in the public's mind such as tort reform, selling insurance across state lines and accountable care organizations. The nuanced, serious work to contain rampant self-interest and overcome resistance to change seems very unlikely to happen in our polarized political situation. In fact, the realistic oversight of government in this field and the fine-tuning of the Affordable Care Act are desperately needed but cannot happen in a "for and against" environment. Government can be a (versus the) problem.

In my mind, government is going to have to play a significant role in reform; the needed changes are not going to evolve solely through more freedom for the health care market. However, room for entrepreneurial health care services has to be created. Trade restraints need to be seriously reconsidered, with pharmaceuticals a prime example. Health care is going to have to become more transparent. Consumers need to be armed with better information and encouraged by payors to act on that information. Cheaper and better has to become an incentivized goal for health care providers - that would be a seismic change. All of this will be a test to see if health care can become a true market; there are plenty of reasonable, well-informed doubters.

Health philanthropy will need to continue to do what it can to speak up for the consumer, work hard on access for all, and assist those who are trying to innovate and provide quality services at lower cost. That is where the Health Ministry Fund will continue to work in 2016, but we will remain on the lookout for new opportunities to join with others to create a more promising dialogue dealing with the realities versus the ideologies.


Kim Moore,
February 2016
[read more reflections on our staff blog - To My Way of Thinking]




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