Noonletter, Oct. 23, 2018

Oct 23, 2018
Originally published on October 18, 2019 6:59 am

Super(natural?) savings

Kris Kobach contends that he could cut nearly $2 billion from the cost of Kansas Medicaid budget.

The hard-line conservative Republican running for governor sees a way to cut those costs by adopting direct primary care, also known as concierge care.

It’s a small part of the private health insurance market today. Typically, a patient pays a flat, Netflix-like subscription fee to cover mostly unlimited access to a doctor’s office instead of using conventional health insurance. It’s basically a way to promise income to physicians and cap costs for the patient while trimming away the hassles and expense of insurance claims.

The catch is that it doesn’t cover care from specialists or long-term care — the priciest part of the state’s Medicaid bills.

And there’s the rub. Reporting by Nomin Ujiyediin showed a certain, um, implausibility to Kobach’s claim.

The bulk of any savings from direct primary care would come, of course, from primary care.

The elderly and disabled make up about a fourth of the people getting Medicaid or the related Children’s Health Insurance Program in Kansas. But they account for 70 percent of KanCare’s spending. And most of the cost of covering them isn’t primary care. Rather, it’s the cost of long-term and nursing home care.

In fact, in 2016, the state spent just $315 on million physician services and outpatient care — essentially the area where Kobach contends the state can cut costs by $1.9 billion.

Kobach’s campaign doesn’t give much explanation, but Ujiyediin breaks things down for you.

Spoiler alert

Greg Orman’s independent run for the U.S. Senate looked so promising in 2014 that the Democrat in the race dropped out to give him a clear shot at Republican incumbent Pat Roberts. A three-way race, went the thinking, would clinch things for the GOP.  Orman made Roberts sweat, but couldn’t beat him.

This year Kansas has, guess what, a three-way race for a major statewide office. Yet this time it’s Orman who’s seen as the guy who could split the vote just enough to leave the Republican — Kobach — with a winning plurality in the governor’s race.

The latest episode of the “My Fellow Kansans” podcast talks at length with Orman and examines his wild-card status in a race where polls show him struggling to break out of single figures. It’s worth a listen.

Polarized lenses

Polls tell us the fight for the 2nd Congressional District — basically the eastern third of Kansas, minus the Kansas City suburbs — is as close a call as you’ll find in the country.

The seat’s been in Republican hands for a while. But U.S. Rep. Lynn Jenkins isn’t running for re-election. Democrat Paul Davis, a former state representative, lost a run for governor four years ago but won within the district. He’s up against a newcomer to politics, Army combat veteran Steve Watkins.

Much about the race reflects national red-v.-blue animosity, notable in a series of attack ads run by the campaigns and outside groups.

Jim McLean went to a debate between the candidates Monday night and picked up on a moment that is All-America, All-2018.

How, the candidates were asked, can they bridge the country’s increasingly ugly political divide?

For starters, Watkins suggested, just elect more Republicans.

“You know, it’s the Democratic Party here that, among other things, they’re calling for mob politics.”

Davis: “His idea of how we cure this divide is more partisanship.”

Speaking of tribalism ...

How you read this tweet — hearty agreement with the inherent criticism of racism, or angry rejection of that snowflake-sensitive premise — probably says a lot about how you’re feeling about politics these days.

Ah, democracy.

Get out of jail (not so free) card

Dan Margolies has been documenting the way prisoners held at the Leavenworth Detention Center had their conversations with attorneys listened to by prosecutors.

The latest case has ended with a woman being released early from a prison sentence because prosecutors listened to her phone calls with her attorneys.

Rural reboot

About three years ago, the Federal Communications Commission decided it would auction off access to 5G frequencies (the wireless folks make big promises about this coming technology) by census tracts.

That was encouraging to smaller internet companies. Census tracts are relatively small. They typically cover 2,500 to 8,000 people. Small companies figured they could afford to bid for those licenses, and hoped to beam some form of broadband to local customers.

On Tuesday, the FCC decided instead to sell (cell?) those frequencies in bigger, county-sized chunks. The big telecoms such as Verizon and AT&T prefer that. They want to cover large swaths and don’t want to bother with tiny sections. Plus, their size will give them an advantage in bidding against the smaller players.

Ujiyediin reports the smaller operators now worry, with the FCC changing course, that they’ll be priced out of the game. They also say Big Wireless won’t have the same incentive to spend money on infrastructure in rural areas when the overwhelming majority of their customers care chiefly about coverage in cities and suburbs.

Scott Canon is digital editor of the Kansas News Service, a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio covering health, education and politics. You can reach him on Twitter @ScottCanon.

 Kansas News Service stories and photos may be republished at no cost with proper attribution and a link to ksnewsservice.org.

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