A Republican proposal to replace the Affordable Care Act would effectively block states’ ability to expand Medicaid, thwarting a new attempt by Kansas to expand its own privatized version of the program.
Congressional Republicans have continued to push forward with the GOP’s American Health Care Act, which would repeal and replace the 2010 Affordable Care Act, widely known as “Obamacare.”
The Republican bill has struggled to find widespread support, even in the Republican-controlled Congress. Changes made by Republican leaders on Monday in an effort to attract more conservative votes would take away the financial incentive for states looking to expand Medicaid: the federal government’s offer to match roughly 90 percent of a state’s costs to expand coverage.
Taking out that provision could hurt the expansion effort in Kansas, just after the legislation passed the House and is now in front of the state Senate health committee.
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“Under this version of the bill, there would be no financial incentive for the state to expand,” said Adam Searing, research professor at Georgetown University’s Center for Children and Families. “With the rest of the cuts in the bill, they would actually be in worse shape.”
The Kansas legislation, passed by the House last month, would require that federal money continue to cover most of the costs for expansion to remain in effect.
Asked by McClatchy whether an exception could be made in the GOP bill for Kansas or other states that pass Medicaid expansion, White House spokesman Sean Spicer suggested Kansas would be out of luck.
“It would be addressed in the legislation,” he said. “I don’t believe there’s an exception clause.”
Spicer added that he didn’t want “to prejudge the outcome yet” as the bill prepares to go to the U.S. House floor for a vote.
Rep. Dan Hawkins, a Wichita Republican, said that if the federal funds fall below 90 percent, the Kansas expansion would phase out.
“It is going to go away,” said Hawkins, an opponent of expansion. “The federal match, they’ve signaled that for a long time now. ... Why would we go on and expand and then have to stop it? That’s a horrible, horrible, policy position.”
Expansion supporters said they are focused on moving forward under the Affordable Care Act and will reconsider only after President Donald Trump signs health care changes into law.
“It’s a proposal to a proposal that hasn’t even gotten out of a single chamber of Congress yet,” said Sheldon Weisgrau, director of the Health Reform Resource Project.
David Jordan, executive director for the Alliance for a Healthy Kansas, struck a similar note.
“It’s in the best interest of Kansas to move forward to expand the KanCare program,” Jordan said. “We have everything to gain and nothing to lose.”
Kansas Senate leaders said earlier this week that they expect House Bill 2044 to pass out of the Senate health committee in the next few days. The House passed the bill last month, 81-44.
It’s unclear whether the bill will have such strong support if it makes it to the Senate floor.
Susan Mosier, the state’s secretary of health and environment, has joined Gov. Sam Brownback and spoken out against the expansion effort.
Mosier testified to lawmakers Tuesday that expansion would be a significant cost to the state as it faces projected budget shortfalls of more than $1 billion through June 2019.
“A lot of what’s going on in Washington, D.C., will impact what happens here,” Mosier said. “We can move forward, but it depends upon what happens in D.C. what we’ll be able to do.”
KanCare, the state’s privatized Medicaid program, covers more than 400,000 pregnant women, children and low-income Kansans.
Expansion supporters have testified that roughly 150,000 people more would be able to get KanCare if coverage is expanded.
Tuesday’s hearing ended two days of testimony in Topeka, where hundreds of supporters either spoke to lawmakers or wrote to them.
Doctors, health care organizations and people that would benefit from expansion testified in support of the bill Monday. Mosier, along with lobbyists from conservative policy groups, testified against the bill Tuesday.
“Now is really just not the time for an eleventh-hour Medicaid expansion,” said Melissa Fausz with Americans for Prosperity.
Sen. Ed Berger, a Hutchinson Republican, said the opponents’ testimony, or the congressional Republicans’ proposed changes, didn’t dissuade him from supporting expansion.
“I think it’s going to be a while before we see any clear direction from the feds,” Berger said.
Said Sen. Barbara Bollier, a Mission Hills Republican who supports expansion: “If it’s 2020 before any significant changes come (from Congress), we will have lost more valuable money and resources to care for the citizens, the patients, in this state. That’s not how you make decisions, on what might happen.”
Anita Kumar of the McClatchy Washington Bureau contributed to this report.