1. Rick Kahle and Danette Wilson directed a two-hour conversation that repeatedly came back to the challenges of providing quality patient care at a reasonable cost. | 2. Joseph Galate asked a pointed question about who was profiting from higher health-care costs. | 3. Bob Finuf noted the comparatively unusual position Children’s Mercy Hospital was in because of its large base of Medicaid Patients.

“Affordability is the No. 1 thing we hear from our customers,” said Danette Wilson, “and that pressure continues to mount.” As she explained, customers are demanding affordability, saying that they cannot pay any more, and providers are saying they need more money to handle the ACA and to continue to invest in their businesses. “That’s a very tight rope and a major challenge for us,” Wilson added.


The Medicaid Gap

Rick Kahle spoke to the gap between those patients eligible for Medicaid and those eligible for ACA subsidies. “The providers were supposed to give some and get some in return,” said Kahle, “but that has left a pretty significant hole.”

Bob Finuf, a vice-president at Children’s Mercy Hospital, observed that Children’s is relatively fortunate in that both Kansas and Missouri have higher-than-average levels of eligibility from an income perspective, particularly in the Children’s Health Insurance Program. The lack of expansion for adults is, as he sees it, “a significant issue when we already start at such a low place.”

Tierney Grasser, senior vice president of finance and chief financial officer at Olathe Health System, spoke to the “huge gap” between Medicaid and the subsidy-eligible population under ACA. Asked Kahle, “So somebody making be-tween $4,000 a year and $12,000 a year, while the intent of the ACA was to help those individuals get access to coverage, the fact is, it doesn’t?” Confirmed Grasser, “A lot of people are saying they can’t afford the gap.”

For Olathe Health System, this means finding resources in the age of added technology and added regulation. “In fact,” said Grasser, “the uninsured have actually increased the first part of the year.”

Danette Wilson noted that one of the biggest disappointments about the ACA was that it had been developed to help provide health insurance to all people who were without it, “but it really hasn’t put much of a dent into the uninsured at all.” Only about 20 percent of those enrolling in Blue Cross’s individual plans did not have insurance before.


Cost Issues

Joseph Galate, a physician and medical director of Metro Spine & Rehabilitation, posed a “stupid question” that was not stupid at all. “I really don’t know where the health-care dollars are going,” said Galate, “I don’t know how it breaks down. I mean, they’re saying our health-care costs keep going up every year. Where are they going? I know I’m not being paid more.”

As Rick Kahle explained, the rate of health-care cost increases has actually been lower in recent years than in the past. As to why the prices continue to rise, Danette Wilson noted that there had been no downturn in utilization at all. “So we continue to see prices go up because of technology, number one.”

Added to that is the pressure from an aging population. This means more tests and more services. “So we’re not seeing a flattening of claims,” said Wilson. Pharmaceuticals play a large role in upward cost pressures as well, especially biologics, which Brian Burns, senior vice president at Blue Cross Blue Shield of Kansas City, described as the “eighth wonder of the world.”

“There absolutely are providers being paid less for the same services,” said Kahle. “It’s not universal, but that’s absolutely the case.” He asked whether costs were being shifted from the government to the private side. Jean Hansen, CEO of Kansas City Internal Medicine, explained that providers had worked hard on cost effectiveness, “But there comes a point where there isn’t much to get out.”