Over the last five years, Sheldon Weisgrau has given more than a hundred presentations in dozens of Kansas counties urging support for Medicaid expansion under the Affordable Care Act.
He was told often that he and other advocates were wasting their time — that expansion would never get the votes in the Legislature. Not in a red state like Kansas.
Then, on Tuesday, it did.
The bill still faces a likely veto by Brownback.
But the votes were a dramatic turnaround that Weisgrau, a Lawrence resident who leads the Kansas Association for the Medically Underserved’s ACA implementation efforts, attributed to a grass-roots push from Kansans who aren’t usually involved in the political process.
“I think health care is absolutely different than most public policy issues people deal with,” Weisgrau said. “It’s very personal. I think a lot of people view it in a very personal way and see how it affects them or their family or friends and neighbors.
“This has been a long time coming,” he added.
The legislative fight began in June 2012, when the U.S. Supreme Court upheld the constitutionality of most of the ACA but ruled that states should decide individually on Medicaid expansion, which extends public health coverage to everyone who makes up to 138 percent of the federal poverty limit.
States controlled by Democrats, and a few controlled by Republicans, signed on because the federal government promised to pick up 100 percent of the tab in the first three years and no less than 90 percent in the long-term. Missouri and Kansas are among 19 Republican-led states that declined.
KanCare, the state’s privatized Medicaid program, continues to be accessible mainly to low-income children, pregnant women and people with disabilities.
For years, Medicaid expansion bills could not get a hearing, much less a vote in deep-red Kansas. But pressure built from hospitals that stood to gain financially from treating fewer uninsured patients and progressive voters galvanized by the issue and the state’s ongoing budget problems.
Last November was a turning point. The Legislature took on a more centrist look as candidates who made expansion a centerpiece of their campaigns, like Rep. Cindy Holscher of Olathe and Sen. John Skubal of Overland Park, defeated staunch expansion opponents.
Leawood resident Michele Neylon said Skubal’s predecessor, Sen. Jeff Melcher, wouldn’t listen to arguments in favor of expansion and it frustrated her.
“I’m pleased moderates have gotten at least a little control,” Neylon said. “I just decided I need to be more vocal.”
When expansion got a hearing this year, Neylon submitted testimony for the first time. So did Edward Acosta of Olathe and Roxanne Belcher of Overland Park.
Acosta, a retired social worker for the U.S. Department of Veterans Affairs, said he had watched uninsured military veterans who weren’t eligible for care at VA hospitals struggle to manage chronic illnesses. He was also concerned about the future of his 2-year-old grandson, who has a seizure disorder.
Neurological problems run in his family, Acosta said, and it’s made him more sympathetic to expanding KanCare.
“The moral argument wins, hands down,” Acosta said.
Belcher, a librarian, weighed in on expansion after her son turned 26 and was no longer covered under her insurance plan. She said behaviors caused by his mental illness landed him in jail and the Osawatomie State Hospital in the past, but his application for KanCare currently depends on him being designated as disabled.
Belcher said she didn’t feel “super-informed” about politics, but turning away federal money while the state struggles to provide care to the mentally ill never made sense to her.
It means “more people being insured, which is really good, like adults who don’t have a disability but are living in poverty,” Belcher said. “I’m happy that it seems like we’re going in the right direction.”
Wyandotte County residents also weighed in. With Congress weighing repeal of the ACA, Unified Government Mayor Mark Holland helped organize a letter-writing campaign earlier this month that drew more than 500 responses urging the local delegation to reconsider. Holland has been an outspoken advocate for expansion, which stayed alive when the repeal effort fizzled Friday.
Jerry Jones, the executive director of the Community Health Council of Wyandotte County, said county leaders have worked hard to lower the uninsured rate, but it remains one of the highest in the state.
“Medicaid expansion would be huge, of course, for Wyandotte County in particular,” Jones said. “For our residents as well as our providers. We obviously are excited about what happened in the Senate today, and we know the governor is going to weigh in, and that’s fine.”
Brownback will have 10 days from the time he gets the bill to decide whether to veto it, sign it or let it become law without his signature. Conservative and business groups opposed to increasing government’s role in the health care sector and concerned about the cost to the state have already urged him to veto it.
Asked for a comment about the governor’s plans for the legislation, Brownback’s spokeswoman Melika Willoughby referred to Brownback’s previous statement that “to expand Obamacare when the program is in a death spiral is not responsible policy.”
Marcillene Dover, who started pushing for expansion shortly after she was diagnosed with multiple sclerosis in 2014, said she was “disheartened” by the governor’s opposition.
Dover, 23, is now a first-year physics teacher at Wichita North High School with full insurance coverage through her job and access to a specialist at the University of Kansas Hospital.
But when she started her advocacy she was a quiet, uninsured college student who made multiple trips to Topeka to tell legislators about the dual fears caused by her diagnosis: What is going to happen to me? and How am I going to pay for this?
“I am very proud that the Kansas Legislature actually stood up and did something for the vulnerable people living in Kansas,” Dover said after Tuesday’s vote.
If Brownback does veto the bill, it will take 84 votes in the House and 27 votes in the Senate to override his veto. That may be a tough task, as conservative lawmakers were already saying after the vote that they would not be flipped and were hopeful the Senate, or even the House, could defeat a veto override effort.
Senate President Susan Wagle, a Wichita Republican, voted against the expansion effort, saying that the bill was not “revenue neutral.”
Asked whether she would reconsider in the case of a veto override effort, Wagle said, “No.”
“I think this does add a cost on to the state,” Wagle said. “And I also believe the feds will not stick with their end of the bargain.”
Weisgrau said the advocates who have been focused on getting a vote on expansion for years will now shift their focus to urging the governor not to veto it, and urging the Legislature to override his veto if he does.
How they voted
Here’s how senators from Johnson and Wyandotte counties voted on House Bill 2044 to expand Medicaid:
Yes votes in the Senate:
Republicans: Barbara Bollier, John Skubal, Dinah Sykes
Democrats: David Haley, Pat Pettey
No votes in the Senate:
Republicans: Molly Baumgardner, Jim Denning, Steve Fitzgerald, Julia Lynn, Robert Olson, Mary Pilcher-Cook