At a Republican governor candidate forum in Garden City, Wednesday, former doctor Jim Barnett said expanding Medicaid would save lives and communities – by keeping rural hospitals running. But he was alone in his support of the state and federal program that defrays medical costs for people with limited income and resources.

Other candidates decried Medicaid’s cost and the management of Kansas’s privatized Medicaid delivery system, Kancare. Secretary of State Kris Kobach announced his intention to massively overhaul the system.

Barnett said Kansas should expand Medicaid for humanitarian reasons. Studies show that health outcomes improve in states that expand Medicaid.  Adult and infant mortality rates decrease compared to states that didn’t expand the program.

“If you don’t have access to healthcare, you wait until it’s too late,” Barnett said. “Children and adults in this state die because of lack of access to healthcare, through no fault of their own.”

Barnett argued that expanding Medicaid would benefit rural communities as well.

“There are 30 hospitals – rural hospitals – on the edge of closing,” Barnett said. “If you lose your hospital, it’s like losing your school. If you want to attract business, you’d better have access to healthcare.”

Lt. Gov. Tracy Mann, who represented an absent Gov. Jeff Colyer, opposed long-term costs and risks associated with Medicaid expansion.

“Basically, you’re hitching your wagon to a horse and you don’t know how far … or where it’s going to go” said Mann. “States that have gone down that road have had major problems.”

Mann said Colyer, who is also a plastic surgeon, has already supported legislation to try to keep hospitals running in the state.

“An effective way to get more money to hospitals is by increasing the reimbursement rate,” said Mann. “The Governor championed that. That got into the legislation that was passed in this year’s budget.”

Secretary of State Kris Kobach also opposed expansion. To reform healthcare in Kansas, Kobach said he would first ask President Trump for an exemption from The Affordable Care Act, also known as Obamacare.

“We have the opportunity to ask for a waiver, and we now have a president who dislikes Obamacare. Let’s take advantage of that situation.” Kobach said. “It boggles the mind as to why Gov. Colyer has not made such a request.

At the forum, Kobach also announced for the first time that he wants to completely overhaul Kansas’s Medicaid system, switching it to a direct primary care system.

“I’ll be launching a major reform of Kancare,” Kobach said.

Direct primary care, also known as concierge medicine, is an emerging healthcare delivery model. It’s an alternative to traditional healthcare where doctors bill insurance companies for each procedure or prescription. Instead, doctors charge patients a periodic fee for primary care services. Advocates of the system say it can save money by reducing administrative costs.

“It slashes the cost of providing excellent care,” said Kobach. “The $3.2 billion we are spending for 400,000 people would go down to $1.3 billion.

However, critics of direct primary care say it would aggravate existing shortages of primary care doctors because, through that system, each doctor typically sees fewer patients. They also point out that patients may still need separate insurance to cover expensive procedures like cancer treatment.

Insurance Commissioner Ken Selzer and “evangelical entrepreneur” Patrick Kuchera also attended the forum.

The primary to select the Republican candidate for governor and candidates for other state offices will take place Aug. 7.

A forum for Democratic governor candidates will take place at Garden City High School on July 24.

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At Garden City Forum Barnett Urges Medicaid Expansion, Kobach Wants Complete Overhaul