PITTSBURG, Kan. — The vote felt like a blow to Suzan Emmons.

Kansas came close this week — achingly close — to expanding Medicaid to extend health insurance to low-income adults like her. The Republican-dominated Legislature had passed the bill and supporters vowed to override the governor’s veto. But on Monday, the House fell three votes short.

“I’m very angry. It’s almost hurtful,” said Emmons, 56, who makes just under $13,000 a year cleaning houses and can’t afford insurance on her own. “They don’t realize I’m not looking for something given to me. They think it’s just a bunch of bums on welfare looking for a handout. It’s not. It’s working people.”

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The failed veto override also crushed hospital executives and community clinic directors who had hoped against hope for a Medicaid expansion, which would have brought in a flood of federal dollars to help pay for the care they now often deliver for free. The expansion would have covered an estimated 150,000 Kansans.

Activists, including the Kansas Hospital Association, promised to keep fighting.

“We’re not ready to give up yet,” said Sheldon Weisgrau, director of the Health Reform Resource Project, which has been pressing for expansion. “It’s not over until the gavel falls at the end of the legislative session” next month.

“I find it hard to believe all that momentum will die,” said state Representative Monica Murnan, a Democrat from this small town in southeast Kansas. “It will come back in another fashion.”

The staff at the Community Health Center of Southeast Kansas can only hope so. This is the poorest and sickest corner of the state, and a great many adults lack health care coverage. Some 35 percent of the clinic’s patients are uninsured, CEO Krista Postai said. Many work two and three jobs but still can’t afford health insurance.

“We probably had better access to health care 100 years ago than we do today,” Postai said.

Patients at the clinic pay on a sliding scale, based on their income. The base price for a visit to the doctor is $15. But no one is turned away.

The clinic launched in 2003 in a cramped trailer divided into four exam rooms. Now, it operates out of a bright and modern 57,000-square-foot building with 50 exam rooms. It’s a few blocks from the four-lane road heading through this former coal-mining town, which is home to Pittsburg State University.

In addition to standard medical and walk-in care, the clinic in Pittsburg offers dental, mental health, and addiction services. An optometrist comes twice a week, and specialists in hepatitis C, HIV, and nephrology visit regularly. The clinic also has a lab, an X-ray machine, and its own pharmacy. There’s even a fitness room.

Postai said the sickest patients struggle when they need to find a specialist outside the clinic’s areas of expertise, like a cardiologist. Most such physicians are reluctant to take charity cases, or will accept just a few uninsured patients each month. And paying out of pocket can be prohibitive: A consultation with a specialist can cost $500 up front.

The clinic has just started with working with a telemedicine company out of Wichita that has agreed to provide access to specialists on a sliding scale. But those consultations have limited value for patients who need surgery or expensive drugs. Medicaid, Postai said, was their best bet, and she plans to keep pushing for Kansas to join the 31 other states that have expanded the program under Obamacare.

“We got really, really close. This is not the time to give up,” Postai said.

The clinic here was set up to work with uninsured patients, so Postai said it will survive even without Medicaid funds.

Rural hospitals, however, are a different story. Across rural America, small-town hospitals have been closing, or struggling to keep their doors open. The same holds true in Kansas.

Rural Hospital Closures: 2005 – 2016

Press play or drag the timeline handle to see the locations of rural hospital closures over the last decade. The size of the bubble represents the number of hospital beds.

Total for JAN 2005 -

Talia Bronshtein/STAT Talia Bronshtein/STAT Source: The North Carolina Rural Health Research Program GIF / Youtube

Some 60 miles down the road from Pittsburg, in the town of Chanute, Dennis Franks runs the Neosho Memorial Regional Medical Center. He said expanding Medicaid would have brought the hospital $1.4 million in 2018 and $2.9 million in 2019 — money desperately needed to recruit physicians and update equipment.

“It means a great deal to the hospital and the patients in this community,” he said. “Right now we’re on the bubble like other hospitals. It’s like death by a thousand cuts.”

When he vetoed expansion the Medicaid expansion late last month, Governor Sam Brownback said the proposal was riddled with flaws: “I am vetoing this expansion of Obamacare because it fails to serve the truly vulnerable before the able-bodied, lacks work requirements to help able-bodied Kansans escape poverty, and burdens the state budget with unrestrainable entitlement costs.”

Dr. Greg Lakin, a Republican lawmaker from Wichita and an osteopathic doctor, sided with the governor, in part because he expects Congress and the Trump administration to shake up the health care landscape — and he didn’t want to get locked into any decisions before that happens.

“The timing didn’t make sense,” he said.

In the meantime, residents like Sandra Powell wait anxiously for help.

A 63-year-old widow, Powell cares for her 13-year-old grandson and worries about what might happen for him if her health fails. She already has diabetes and high cholesterol — and yet didn’t go to the doctor for three years because she had no insurance, until she started visiting the community clinic. Powell lives on $721 a month from her husband’s pension — too much for Medicaid and not enough to buy insurance on her own. “I’m stuck,” Powell said.

“We survive,” she added. “That’s what it’s called. Surviving.”

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  • The 63 yr old woman who lives on $721 a month and raising her 13 yr old grandson–is she receiving welfare, etc for the grandson which makes her income too high to receive Medicaid?

  • If people and the elected officials bothered to read their history, they would see the truth and facts for what they are.
    Prior to medicaid, people got taken care of and a lot better than under medicaid.
    I am still looking in the constitution to where it says health care will be supplied by the govt.
    If medicaid was abandoned today, it would go back to the Churches, where it had been for well over a thousand years. I see these big government supporters say, HEY, DO NOT MIX CHURCH AND State. yET, the churches took care of health care and sick people for thousands of year. The govt takes it out of the the Churches vocation, as health care and peoples welfare is the job of the church, and these people say SEPARATE CHURCH AND STATE, yet when it is Medicaid, these big govt kool-aide drinkers seem to forget their own rules. Yes, it is only what they say, and it is ok if they change the rules, but no one else can.
    Who has the cojones to sue to govt for all the churches across the world to get this job back. The biggest hospital systems in the world
    1. Seventh Day Adventist, 2. Catholic Health Care, 3. Baptist Health Care.

    The facts speak for themselves. The Govt communists, took the very job of the Churches and yell separate church and state, and yet, they do not even do as they say. Hypocrites.
    If the Churches ran medicaid, there would be very few problems. And the poor would get health care of excellence.
    Right now, Medicaid is atrocious for giving out opiates, and low grade medicines, and low grade therapies, and cheap therapies, that really do not help the patient, they just keep the poor in bondage.
    The churches gave health care of excellence and it took the poor out of bondage. Any one that supports medicaid is evil beyond evil.
    The solution was there, and those evil people, stole the job from the church
    so they could put patients and the poor into bondage.

  • There should be something legally equivalent to war crimes to charge Governor Brownback with for what he is doing to the people of his state. Shame on him. Let’s take away his taxpayer subsidized top-of-the-line healthcare and put him and his family out on the open healthcare marketplace. It’s absurd to have people untouched by the actual healthcare marketplace making choices for millions of vulnerable people.

    • ALL elected officials should only have healthcare coverage the same as they choose for everyone else. Also not let ANY elected official stay in office more than three elections because they get too comfortable and forget the low income seniors and families struggling to survive also helped elect them.

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