MANHATTAN — Greeley County Health Services project director and Wallace County farmer Chrysanne Grund says challenges woven into health care delivery in sparsely populated areas of Kansas were often revealed at a personal level.

“We know all our patients by first and last names,” Grund said. “We know those who don’t have insurance, who may be spending exhorbinant amounts every month on out-of-pocket costs.”

She said hard-working folks in frontier counties in western Kansas — Greeley and Wallace counties are two of the least populated in the state — struggled to afford preventative and emergency care, while hospitals and clinics serving those populations absorbed realities of uncompensated care, low patient volume and intense competition for physicians.

One piece of the solution, she said, would be for Kansas to expand eligibility for Medicaid for as many as 150,000 low-earning Kansans — just as the four neighboring states have done.

“Medicaid expansion would add to the economic stability of our health system,” Grund said.

Gov. Laura Kelly, who has championed Medicaid expansion, invited Grund and others with insights into the agricultural economy Wednesday to an informal discussion of rural health care access at offices of the Kansas Farm Bureau in Manhattan. It was among stops on Kelly’s statewide tour to encourage the 2024 Legislature to debate and vote on a Medicaid bill.

In 2017, the Legislature approved Medicaid expansion but the measure was vetoed by Republican Gov. Sam Brownback. The House adopted an bill in 2019, but the Senate didn’t consider it. Kelly and the Senate’s majority leader, Jim Denning, crafted a Medicaid expansion bill in 2020, but it stalled. GOP leadership of the House and Senate have maneuvered since then to thwart expansion legislation aimed at providing affordable, accessible care for the working poor in Kansas.

“They’re in the food service industry. They’re in home health care. They’re in day care,” Kelly said. “They’re doing the jobs that are absolutely essential, but don’t provide employee-based insurance.”

Kelly said the Center for Healthcare Quality and Payment Reform estimated 60 of 104 rural hospitals in Kansas were at risk of closing. During the governor’s Medicaid expansion tour in Pittsburg, Topeka, Overland Park, Salina, Winfield, Garden City and Wichita that began in September, the Herington Hospital was closed and a Fort Scott emergency facility operated by Ascension Via Christi was shut down.

Affordability crisis

Thad Geiger, a farmer and former banker in Doniphan County in northeast Kansas, serves as chairman of the Kansas Board of Agriculture. In advance of the forum, he made a few calls to gather ideas from others about access to health care and potential of Medicaid expansion.

“Expanding Medicaid is great. More healthy people is better,” he said. “But the whole system is just so messed up. We’re giving blood to the patient, but we’re not healing.”

He penciled out the distinction between securing private health insurance of the past and doing that in today’s marketplace. He said there was a time when a farmer could spent 10% of gross income on a family health insurance policy, which might consume annual profit on 30 acres to 50 acres of crops.

In contrast, he said, one of today’s young Kansas farmers with a spouse holding down a public-sector job had to confront an annual $24,000 health insurance bill that carried a high deductible. It could cost farm profit from several hundred acres of crops to pay that annual cost, he said.

Nick Levendofsky, executive director of the Kansas Farmers Union and a crop-and-cattle farmer in Republic County, said expansion of Medicaid would funnel hundreds of millions of dollars in federal and state funding into the Kansas health care system.

The reform would help individuals avoid health care debt and reduce the level of  uncompensated care provided by hospitals and clinics, he said.

“But, most importantly, it would preserve and strengthen these rural communities,” he said.

Mental health gap

A&H Farm owner Andrea DeJesus operates a business in Manhattan that markets vegetables and fruit while also engaging in row crops, livestock and agrotourism. She said there was a significant unmet need across rural Kansas for mental health services, which would be part of an expanded Medicaid initiative.

“I see problems with mental health,” said DeJesus, a point driven home by others on the panel. “I don’t think there’s enough support for that, especially in the farming industry. It’s such a mental job.”

Erin Petersilie, assistant director of Kansas Farm Bureau Health Plan, said 16,000 people had signed up for KFB coverage since the Legislature adopted a law several years ago allowing marketing of plans that didn’t conform to the Affordable Care Act. She said consumers would get around to asking questions about pregnancy and emergency care or the nuts and bolts of how the program worked.

“Mental health — you might be surprised — that’s the No. 1 question that I get when somebody calls,” she said.

Matt Splitter, a fifth-generation farmer in central Kansas, said steps had to be taken to move care and treatment beyond mental health hotlines.

“When it becomes a tragedy, it’s too late,” he said. “How are we being proactive?”

He said the health care system — through Medicaid and other means — had to appreciate the reluctance of farmers to seek mental health treatment in their own community. While some people prefer telemedicine options, he said others would seek face-to-face care. For some, that would mean travel to distant cities to see a specialist. The stigma of not looking mentally weak was still that strong, he said.

“I wouldn’t be caught dead with my pickup in front of a counselor in my hometown,” Splitter said.