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Some lawmakers have expressed skepticism about Brownback's predictions of how much KanCare will save.
"I have concerns that the amount of money that is going to be saved, that it won't become a reality," says Barbara Bollier, a Republican House member from Mission Hills whose district includes Bullers' home. "That remains to be seen, and it may. I'm a physician, and I married a physician, and I'm well aware of how hard it is to control costs in the medical realm."
KanCare contracted the state's Medicaid to three private managed-care organizations: UnitedHealthcare Community Plan, Sunflower State Health Plan and Amerigroup. Those three have contributed directly and indirectly to Brownback's coffers, according to records with the Kansas Ethics Commission.
Centene Corporation, which owns Sunflower State Health Plan, donated $2,000 to Brownback's election campaign in 2012. Kansas Association of Health Plans, a nonprofit whose board of directors in 2010 included employees of both UnitedHealthcare and Amerigroup owner WellPoint Inc., also contributed to Brownback's war chest, in 2010.
All three companies are publicly traded, so their obligation is first to their shareholders, which they do by maximizing profits.
It's widely speculated that Brownback wants to run for president in 2016. (His 2008 effort fizzled early; the career politician's Senate record wasn't strong enough to mount a serious campaign.)
Many of Brownback's directives since becoming Kansas governor — eliminating income taxes on several types of businesses and privatizing Medicaid — have been viewed by opponents as steps to bolster his conservative credentials for a more fruitful 2016 White House bid.
Brownback has also been a critic of the Affordable Care Act, the national health policy passed by President Barack Obama that has gotten off to a miserable start. KanCare also hasn't fared well. The handoff to the private companies was sloppy. Hospitals and other providers have complained that they haven't been reimbursed by insurers quickly or accurately, especially for patients with long-term needs.
"The process has not gone as smoothly as the people at the Statehouse would have you believe, as far as the implementation is concerned," said Allen Van Driel, CEO of Smith County Memorial Hospital in north-central Kansas, according to a September 23 Kansas Health Institute News Service report. "The party line is that the managed-care plans are working and that KanCare is a huge success, that it's processing claims and all that. But that's simply not factual."
Other hospital executives say they are seeing increases in the number of contested claims.
Brownback officials have passed off such criticisms as "bumps in the road," according to various news reports. De Rocha says managed-care organizations are penalized if they don't make reimbursements within 30 days, and delays are often the result of clerical errors.
"In order to get paid, they have to enter the correct code in the billing mechanism," de Rocha says. "If they don't do that, oops, it gets shot back to them."
When KanCare went into effect, Bullers temporarily lost his in-home care.
"It was a very rocky start, to be honest with you," Bullers says. "They have yet to recover from that."
And not all Medicaid recipients have yet become part of the program. Kansans with developmental disabilities, such as Down syndrome and cerebral palsy, don't become part of KanCare until January 1, 2014.
Johnson County Developmental Supports, a county agency that assists residents with developmental disabilities, predicts some difficulty with signing on to KanCare at the end of the year.