Gov. Sam Brownback signs bill saying Medicaid expansion decision rests with Kansas Legislature

Medicaid won’t expand in Kansas anytime soon.

HB 2552, which requires an act of the Legislature to expand Medicaid through the Affordable Care Act, has been signed by Gov. Sam Brownback, his office announced Friday.

The bill was originally created to require prompt payment from KanCare providers. It was amended on the Senate floor to include legislative approval of a Medicaid expansion.

“It doesn’t take a position on whether or not Medicaid expansion under the Affordable Care Act should take place in Kansas. But what it does say is it should be up to the people’s elected representatives to make that decision,” said Rep. John Rubin, a Republican from Shawnee who carried the amended bill on the House floor.

Rubin agreed that since the Legislature is already finished with its regular session, the issue will not come up again until 2015.

Expanding Medicaid would give coverage to about 78,000 uninsured Kansans. The expansion would be covered by federal dollars for the first years but would eventually require state dollars for part of the cost.

Brownback has repeatedly said that he has not made a final decision on expansion but that he would not support it until problems with the Affordable Care Act are addressed. Signing the bill puts the decision in the hands of lawmakers.

Rubin said he opposes expansion as a fiscal conservative. He noted that Kansas was one of 26 states that sued the federal government over the Affordable Care Act.

“The one part on that lawsuit that we prevailed on — and we spent a lot of taxpayers’ money to prevail on that point — was that the federal government could not force us in Kansas, or any other states, with threats of removing all federal Medicaid funding, could not force us to expand,” Rubin said.

Rep. Jim Ward, a Wichita Democrat, was harshly critical of the governor’s decision to sign the bill.

Ward and Sen. Jim Denning, an Overland Park Republican, both of whom sit on the KanCare oversight committee, originally recommended a prompt payment law to the Legislature.

But after the provision to indefinitely halt Medicaid expansion was added to the bill, Ward became one of its strongest opponents.

“That bill is what I think is endemic with this legislative process under this governor and this speaker and Senate president. There was no hearing. There were no opportunities for people who have a stake in Medicaid expansion to come in and talk about it,” Ward said.

Katrina McGivern of the Kansas Association for the Medically Underserved said legislative approval adds an extra step, but her organization is prepared to work on educating legislators about the benefits of expansion.

Ward said that by signing the bill, Brownback was abdicating his responsibility to decide the issue. Because there are no state funds needed for the first three years, the governor could have approved expansion on his own.

Brownback’s campaign manager, Mark Dugan, said the governor has consistently said that legislative approval should be required to expand Medicaid.

“The constitution requires the Legislature weigh in on issues of spending. Obamacare expansion in Kansas would cost a billion dollars over 10 years. It is vital the Legislature have the opportunity to weigh in on these issues,” Dugan said, referencing a 2013 study by the Kansas Department of Health and Environment on the potential cost of expanded Medicaid after full federal funding stops.

The signing of the bill means that if a Democrat were elected governor this fall, Medicaid expansion wouldn’t be a sure thing.

Rubin seemed to acknowledge that when explaining why he thinks the Legislature is better equipped than the governor’s office to make the decision.

“Governor Brownback’s not always going to be the governor. It’s my fervent hope he’s going to be the governor for four more years after this one, but he may or may not be,” Rubin said. “And even with the governor’s best intentions, the widest diversity of information and opinion on this issue I think can be gleaned from 125 representatives and 40 senators each answering to their own constituency.”

Paul Davis, the likely Democratic candidate for governor, said that no matter who is governor, he hopes legislators “will open a dialogue with health care professionals about the needs of Kansas communities and how Medicaid Expansion could impact local hospitals — but more importantly how it impacts patients.”

This story was originally published April 20, 2014 at 9:42 PM with the headline "Gov. Sam Brownback signs bill saying Medicaid expansion decision rests with Kansas Legislature."