Government & Politics

Medicaid expansion won’t come to Kansas this year after last-ditch effort fails

Medicaid expansion won’t happen in Kansas this year, leaving lawmakers to develop a new plan for 2020 that some Republicans hope will be more conservative.

The Legislature adjourned early Sunday without approving an expansion plan backed by Democratic Gov. Laura Kelly. That marked a defeat for Kelly, who had made expansion a priority during her first few months in office.

Senate Majority Leader Jim Denning, R-Olathe, has said he plans to put a new expansion bill on the Senate floor in January.

“I want to be clear that it’s not a question of ‘if’, but rather ‘when and how’ Kansas expands Medicaid to 19-64-year-olds,” Denning said in a statement last week.

Senate President Susan Wagle, R-Wichita, has called for looking at such things as work requirements for able-bodied recipients or expanding eligibility to people making up to 100 percent of the federal poverty level, instead of 138 percent, which is typical in states that have expanded. The federal poverty level is $25,100 for a family of four.

The Centers for Medicare and Medicaid Services in March allowed Utah to expand Medicaid up to 100 percent of the federal poverty level. The federal government has also signed off on work requirements for Medicaid recipients, but they have been challenged in court.

“The Senate has been very clear in what they plan to do ... I believe they have a plan,” said House Majority Leader Dan Hawkins, a Wichita Republican and one of the most vocal critics of expansion in the Legislature.

Expansion advocates emphasize the consequences of waiting until next year to act. April Holman, director of the Alliance for a Healthy Kansas, said the delay will mean real harm to people who fall in the coverage gap — those who make too much to qualify for Medicaid but too little for subsidies under the Affordable Care Act.

“KanCare expansion is a common-sense policy that the state of Kansas needs to adopt. We will continue to fight to increase access to affordable health care for all Kansans,” Holman said.

A bipartisan coalition had held up passage of the state’s $7.7 billion budget in the House on Friday and Saturday in an effort to pressure Senate Republican leaders to allow a vote on expansion.

But during a vote that lasted more than two hours Saturday night, pro-expansion Republicans abandoned the effort.

“We have worked toward some resolution of the question of Medicaid expansion for Kansas. We have achieved some assurances that have moved the ball in the right direction,” Rep. Don Hineman, R-Dighton, said.

He said those assurances included a commitment from Senate Republican leaders to bring expansion up for debate early next year.

In the end, the House voted 79-45 to approve the budget. The Senate then approved it 26-14.

After 2 a.m. on Sunday, the Legislature adjourned for the year.

“For many of our neighbors struggling with illness or disability, time is something they do not have. Due to the failure tonight, thousands of Kansans will go without health care for another year,” Kelly said following the Saturday night vote.

Kelly praised Democrats for their determination to advance expansion and said they had “stood strong together against pressure, threats, and coercion in an effort to help more Kansans get access to affordable healthcare.”

Hawkins said he and other lawmakers were working to fund government by passing the budget.

“That’s what we were working on and that’s what we’ve been focused on ... so we’re sitting there thinking, I guess, totally different than what they think,” Hawkins said.

Over two days, expansion supporters stopped two budget proposals, but not a third.

The spending blueprint is the only bill lawmakers are required to pass, and that gave expansion supporters a powerful piece of leverage.

Pro-expansion Republicans eventually switched their votes en masse after it became clear the budget would pass.

For their part, Democrats continued to oppose the budget after Republicans switched.

“We have been studying this issue for over five years,” House Minority Leader Tom Sawyer, D-Wichita, said. “Now is the time to debate and vote on KanCare expansion.”

“It’s a shame this coalition didn’t hold today,” Rep. Rui Xu, D-Westwood, said.

Ahead of the vote, legislative leaders spent the rare Saturday session mostly meeting with lawmakers behind closed doors.

“A lot of it was just listening to concerns people had and realizing the ultimate goal was to ensure we have funding for government and that our schools are funded and we had money in there for higher education, mental health … there’s a lot of needs of the state — that was our ultimate goal. That’s what we’re going to make sure we get funded,” House Speaker Ron Ryckman, R-Olathe, said.

Ryckman acknowledged that expansion supporters had been able to generate a greater awareness of the issue and that they had heard from senators about working toward a bill in 2020.

The House effectively overruled Republican leaders earlier this year to pass a Medicaid expansion bill but the Senate hadn’t touched it.

Expansion supporters have been trying for years to get the program into law. The Legislature approved it in 2017, but then-Gov. Sam Brownback vetoed it.

More than 100,000 Kansans could have received health coverage under the proposal. But critics said the costs could prove unaffordable.

The Eagle’s Chance Swaim contributed to this story

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