After years spent opposing past efforts to expand Medicaid, Kansas Senate Republican Leader Jim Denning now has a plan of his own.
But the Johnson County lawmaker’s proposal drew tough reviews from both Democrats and members of his own party.
Denning unveiled a plan Wednesday that could ultimately extend health coverage to thousands of Kansans and would raise tobacco taxes to help offset costs.
“We want to try to get as many Kansans covered with health insurance as we can in the Medicaid market and the non-Medicaid market,” he said.
But his plan doesn’t contain a work requirement, a provision some conservatives consider key. Applicants would complete a work assessment, but employment wouldn’t be mandatory.
House Majority Leader Dan Hawkins, a Wichita Republican, said that while he appreciates Denning’s work, “I cannot support a plan that requires Kansas taxpayers to subsidize welfare benefits for those who choose not work.”
Sen. Ty Masterson, an Andover Republican, noted that the Kansas Republican Party platform opposes Medicaid expansion.
“So the fact we’re trying to expand it as Republicans is unfortunate,” Masterson said.
Denning’s plan comes as he faces a tough re-election campaign next year. And after President Donald Trump and Congressional Republicans failed to repeal the Affordable Care Act (which allows expanded Medicaid eligibility and pays for most of it) the issue is unlikely to disappear anytime soon.
Kansas has come close to expanding Medicaid before. Lawmakers passed a plan in 2017, but then-Gov. Sam Brownback vetoed it.
Expansion supporters tried in vain to advance legislation this year, even going as far as briefly holding up passage of the state budget. In the end, Denning committed to bringing a plan up for debate in 2020.
Even though lawmakers have been fighting for nearly a decade over expansion, the basic deal with the federal government hasn’t changed. If the state allows people making up to 138 percent of the federal poverty level ($25,750 for a family of four) to enroll, the federal government will cover 90 percent of the costs. Some 130,000 Kansans could gain coverage.
Denning’s proposal is more complicated than previous expansion attempts, however.
The Overland Park senator is proposing a dual-track program that would both expand Medicaid and provide re-insurance to health plans sold on the federal exchange. Essentially, Kansas would help insure insurance companies to encourage their participation in the exchange and lower premiums for individuals struggling to afford coverage.
Increases to tobacco taxes would generate about $50 million a year to pay for the re-insurance. A $1 per pack hike has been discussed.
“We’re trying to make it sustainable for the patients, the doctors providing the care, the hospitals, the insurers – the whole universe,” Denning said.
The dual approach depends on federal permission. The plan includes fallback options – such as straightforward expansion – if federal health officials reject his ideas.
In a statement late Wednesday afternoon, Democratic Gov. Laura Kelly expressed little enthusiasm for Denning’s proposal.
“We need a Medicaid expansion plan that is simple, effective and sustainable for Kansas. We don’t need to create extra bureaucratic red tape, raise taxes, and create more hurdles to access to health care.
“We have the opportunity to learn best practices from the 36 states that have expanded Medicaid. It’s important that we get this right to best serve the 150,000 Kansans in need of health care coverage right now,” she said.
The plan represents a role reversal for Denning, who has been a target for ire for expansion advocates. Demonstrators this spring dramatically unfurled banners in the Statehouse, accusing Denning and other lawmakers of having “blood on their hands” for holding up expansion.
But advocates, while raising some concerns, appeared open to Denning’s proposal.
“I think overall we’re really encouraged this conversation is happening,” said April Holman, director of the Alliance for a Healthy Kansas. “It seems to be a good faith effort to expand coverage to tens of thousands of low-wage, working Kansans and we think that’s really important.”
Denning vulnerable next year
Still, Denning faces a tricky path to getting his plan through the Legislature.
First, he will need to contend with his fellow GOP leaders. Senate President Susan Wagle, a Wichita Republican who is running for U.S. Senate, has highlighted her opposition to expansion in her federal campaign. And Hawkins remains a steadfast opponent of the idea.
Second, Denning may need Democratic votes to pass his plan if conservative Republicans reject the proposal. Democrats, who have been pushing expansion for years, are skeptical of the Republican senator’s new proposal.
Senate Minority Leader Anthony Hensley, a Topeka Democrat, said lawmakers should approve a straightforward expansion plan instead of Denning’s two-track solution.
“I think we’re diverting our attention away from the real issue,” Hensley said.
Rep. Cindy Holscher, an Olathe Democrat who is running for Denning’s seat, said the senator works against good policies until it becomes clear progress will happen.
“And then he’ll jump sides,” Holscher said.
Denning said he is pursuing expansion now because Kansas this year finally resolved a nearly decade-long court battle over school funding – a source of budget uncertainty in the past. Lawmakers are now pumping hundreds of millions of new dollars into education after repeated opinions from the state Supreme Court that schools weren’t adequately funded.
“It made no sense to work on a huge entitlement until we knew school finance was (resolved by) the court,” Denning said.
Sen. Molly Baumgardner, a Louisburg Republican, echoed Denning’s comments. She said it’s important to understand “just how much of a weight having school funding unresolved with the courts over the last many years has been.”
As an election year approaches, Denning’s district is one of the most inviting in the state for a Democratic challenger. Voters in the district supported Democrat Sharice Davids over Republican Kevin Yoder for U.S. House in 2018 and backed Democrat Hillary Clinton in 2016.
“I think one can easily say he’s probably the most vulnerable Kansas state senator running for re-election,” Patrick Miller, a political scientist at the University of Kansas, said.