Three weeks ago, I penned a letter to this paper explaining and advocating for HB2066, a change in the current Kansas law to allow nurse practitioners to practice to the full extent that their education, license and experience permit. Twenty-two other states and the federal government already passed this legislation to improve patient access and decrease health care costs. HB2066 was heard, debated and successfully passed out of committee. It was the result of 10 years of educating house members, and headed to the full House for a vote when it was the target of a legislative sleight of hand called “gut-and-go.”
The Leavenworth Times, likely unwittingly, ran a story titled “Rare demonstration of political bravery” describing what happened to HB2066 when it was hijacked and became a Medicaid expansion bill. Most of us have grown up with the catchy “Schoolhouse Rock” jingle and animation in our heads of “How a bill becomes a law,” ostensibly about how legislators do their work. Kansas’ “gut-and-go” isn’t anything close and certainly isn’t brave.
“Gut-and-go” is when something is stuck in a bill that hasn’t gone through any committee hearing process nor been debated. Often it’s an issue legislators really aren’t up to speed on and may not even know the language has been inserted in a bill. Similarly, people who want to be involved in the political process on their particular issue later discover that the bill they’ve been tracking and telling their legislators they are for find out, usually after the fact, that their bill has turned into something else, often something completely unrelated to their issue.
Organizations that monitor government transparency and track legislative policies gauging openness and accessibility indicate that the “gut-and-go” process is among the least transparent in the country, often cutting the public out of debates and making it difficult for constituents to track bills, let alone determine who sponsored them.
In the case of HB2066, all of the previously debated and committee-recommended nurse practitioner legislation was completely removed (gutted) and replaced with unexamined, undebated Medicaid Expansion language. Once the host bill has been parasitically gutted and replaced, the original bill language and the work behind it is usually “dead” unless some other legislator is willing to “gut-and-go” someone else’s bill and hard work. This is often devastating for the original group working hard to pass their issue.
The nurse practitioners, for example, have been working for 10 years and have likely spent more than $250,000 during that time to educate and testify to Kansas legislators on how to increase access to quality patient health care while reducing health care costs by simply allowing full practice authority. Ironically, full practice NPs would have likely naturally solved much of the sought after Medicaid expansion by increasing the supply of medical providers. Increasing capacity or supply naturally and inexpensively provides needed medical providers to rural areas and hospitals in the most need, at the least cost, whether or not Medicaid expansion occurs. Instead, the Democrat-led “gut-and-go” Medicaid expansion will aggravate the current overloaded system with even more demand and expense without any consideration for increased supply of medical providers represented by empowered NPs. Without increased supply of providers, Medicaid expansion will likely just add to large hospital system profits and increase wait times for those on the Medicaid rolls – if they can even find a MD willing to accept Medicaid patients in already full clinics and ERs.
HB2066 Medicaid expansion will head to the Kansas Senate where there is a high likelihood that it will languish and die because of the shenanigans pulled in the House. So Kansans will likely get neither empowered NPs or Medicaid expansion. Perhaps the NPs will be treated more fairly next year to get full practice authority passed into law. That should have happened this year, but instead their work and money was hijacked by politicians cowardly seeking expediency supporting special interests rather than real solutions for Kansas patients and fair treatment of nurses and NPs.
For the record, local Reps. Jeff Pittman (D) and Jim Karleskint (R) voted to gut the nurse practitioner bill and voted for Medicaid expansion while local Reps. David French (R) and Willie Dove (R) voted to support the bill and voted against expanding Medicaid for the able-bodied.
Greg Beck is a Leavenworth Times columnist.