Chanute hospital administrator Dennis Franks bore witness to consequences of crushing poverty and serious illness among uninsured patients in Kansas.

"They put big jars out at gas stations asking for help," Franks told state legislators. "If you need a lung transplant, you put a pickle jar out and maybe, if you're lucky, you might get your transplant."

Questions about access to affordable, quality health care in rural areas of the state drew considerable attention this week during two days of meetings by a special Kansas Senate committee exploring ideas for securing health insurance for low-income Kansans through expansion of Medicaid eligibility or adjustment of the private insurance marketplace. The committee agreed to forward a bill aimed at both goals to the 2020 Legislature.

Franks, chief executive officer of Neosho Memorial Regional Medical Center, said the facility absorbed $6 million annually in charity or uncompensated health care costs. He said Neosho County has a poverty rate of 20.7%, compared to a state average of 12.8%. People worked multiple jobs in that part of southeast Kansas, he said, but many still couldn't afford health insurance.

He said broadening eligibility for Medicaid to about 150,000 Kansans would benefit the people he served and the razor-thin bottom line at the Chanute medical center, which is designated as one of the state's rural critical-access hospitals.

Sen. Ty Masterson, an Andover Republican opposed to Medicaid expansion, said funneling more federal and state dollars into Kansas hospitals wouldn't guarantee everyone proximity to health care that met their needs.

A person might simply live too far away from a facility with the personnel or technology capable of caring for him or her, he said.

"It doesn't necessarily compute for me that expansion of Medicaid equals health care or even equals access necessarily," Masterson said.

Bob Moser, a physician adviser with the University of Kansas Health System Care Collaborative, said Medicaid expansion into Kansas would benefit hospitals and clinics. Moser was Gov. Sam Brownback's secretary at the Kansas Department of Heath and Environment from 2011 to 2014. Prior to that, he practiced medicine for more than 20 years in southwest Kansas.

"I believe, truly, with Medicaid expansion it floats all boats. Providers of all types would benefit from that — not just the hospitals," Moser said.

Under current law, the federal government would pay 90% of expansion costs in Kansas. The state of Kansas would be responsible for the remaining 10%. So far, 36 states and the District of Columbia have deepened eligibility for Medicaid services under the Affordable Care Act passed in 2010.

Eddie Herman, president and chief executive officer at HaysMed, which is part of the University of Kansas Health System, said Medicaid reform wouldn't be a silver bullet for challenges facing rural heath care facilities. He said 86 rural counties in Kansas were serving only 32% of the population, but about half of those people in these sparse counties were over 65 years of age.

Hospitals caring for rural Kansans, especially the critical-access hospitals, could lean on financial resources provided by Medicaid expansion, he said.

"Uncompensated care is killing these small critical-access hospitals," Herman said. "Expanding Medicaid is the right thing to do. It's there to improve access to health care for Kansans, especially in the rural areas."

He said the Hays hospital he managed provided $5 million in medical care to uninsured patients each year.

"What have you calculated expansion would mean for your hospital?" Masterson asked.

"About $500,000," Herman said. "More importantly is the economic development impact for Ellis County alone is $4.1 million."