Gov. Sam Brownback’s office voiced strong opposition to expanding Medicaid Monday as the Kansas Senate began debate on a bill to expand the program three days after a congressional plan that would have barred more states from doing so fell apart.
“To expand ObamaCare when the program is in a death spiral is not responsible policy,” Melika Willoughby, Brownback’s spokeswoman, said in a statement as the Senate kicked off debate on the bill, which would expand Medicaid to cover roughly 150,000 uninsured Kansans.
The Affordable Care Act, also known as Obamacare, enabled states to expand Medicaid, which provides health coverage to the disabled and low-income families, to cover people who earn too little to buy insurance through the federal health care exchange but also earn too much to otherwise qualify for Medicaid.
Nineteen states, including Kansas and Missouri, have yet to expand the program, but the Kansas Senate appeared poised Monday to send legislation to the governor’s desk to enact expansion. Based on Willoughby’s statement it appears unlikely that Brownback will allow it to become law.
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“Kansas must prioritize the care and service of vulnerable Kansans, addressing their health care needs in a sustainable way, not expanding a failing entitlement program to able-bodied adults,” Willoughby said.
The Kansas debate takes place three days after U.S. House Speaker Paul Ryan, a Wisconsin Republican, canceled a vote on a controversial bill that would have repealed the Affordable Care Act and barred states from expanding the program beyond March 1 due to a lack of GOP support. The bill, which had been pushed by President Donald Trump, appears to be dead for the time being.
The uncertainty of the future of Medicaid had been a major talking point used by opponents of expansion. State Sen. Laura Kelly, a Topeka Democrat, said the collapse of the congressional bill “takes away a huge argument against” expansion in Kansas.
The Kansas House passed expansion by a margin of 81-44 earlier this session. That is still three votes shy of a veto-proof majority.
Kelly said she doubts the Senate, which is more conservative by comparison, will pass the bill with a veto-proof majority but she does expect the legislation to pass and advance to Gov. Sam Brownback’s desk.
“It’ll be close, but I’m optimistic that we can get there and the failure of Trumpcare doesn’t hurt,” Kelly said, noting that she still thinks Brownback remains the biggest obstacle to Medicaid expansion in Kansas.
David Jordan, the executive director of the Alliance for a Healthy Kansas, said that Ryan’s decision to pull the congressional bill “removes any doubt that Medicaid expansion will remain in place.”
Senate President Susan Wagle, a Wichita Republican, has previously predicted that the Kansas bill will pass the Senate, but she’s also questioned the wisdom of the policy.
“We’d be entering into a contract with an unreliable partner,” Wagle said, referring to the federal government.
State Sen. Barbara Bollier, a Mission Hills Republican and retired physician who supports expansion, said that it could be several years before Congress makes significant changes to health care law and “until that happens we need to move forward with what Kansans need.”
Brownback could have expanded Medicaid on his own to cover an additional 150,000 Kansans, but in 2014 he signed a bill that required legislative approval before the program could expand. Supporters now say that Brownback should weigh that heavily if the Senate passes the bill.
“If the Legislature passes this, the governor needs to listen,” Bollier said.
Bob Beatty, a political scientist at Washburn University, predicted that Brownback would veto the bill based on his decision earlier in the session to veto a bill that would have rolled back his signature tax cuts to right the state’s finances.
“If he didn’t go along with the budget bill, it’s pretty unlikely he’ll go along with this,” Beatty said.
The vote comes amid speculation that Brownback could be tapped for a post in the Trump administration. “It’s become a very difficult time to figure out where Gov. Brownback wants to go both figuratively and literally,” Beatty said.
Conservative Republicans said Monday morning that they still plan to oppose the bill even after the federal changes failed Friday.
State Sen. Dennis Pyle, a Hiawatha Republican, acknowledged that the congressional bill’s failure to even get a vote did take an argument away from expansion opponents, but said that he would still vote against expansion because he opposes growing government.
“I just think it’s more government,” Pyle said. “We have to look at things from that standpoint.”
Sen. Julia Lynn, an Olathe Republican, said that the time isn’t right to expand Medicaid given the state’s financial problems. The Kansas Department of Health and Environment has previously projected that expanding the program would increase costs for the state.
“It has nothing to do with not having sympathy and empathy for the people affected,” Lynn said. “This is just a fiduciary question. I don’t think we’re in a position to answer that call right now.”
A key provision of the Kansas bill meant to address financial concerns would end expansion if federal funding for expansion falls below 90 percent.
Brownback highlighted concerns that federal funding for expansion would not last in his 2017 State of the State address.
“Promises of limitless ‘free’ money from Washington to cover expanded populations were never going to be kept, but that reality might now arrive sooner than later. For states who took the expansion path, the reckoning could be severe,” Brownback said in his January speech.