Steve Rose

Gov. Sam Brownback shows courage with a softening stance on Medicaid

Kansas Gov. Sam Brownback’s visit to Missouri included a surprising revelation about Medicaid.
Kansas Gov. Sam Brownback’s visit to Missouri included a surprising revelation about Medicaid. The Associated Press

Kansas Gov. Sam Brownback recently traveled to Jefferson City to tutor Missouri legislators on tax cuts. But while visiting the neighboring state’s capital, he made a stunning remark that had nothing to do with his controversial supply side experiment.

Brownback said he was neither for nor against expanding Medicaid, the health care program for the poor, “if it meets his own personal financial concerns.” But he said if he was presented with a proposal to expand Medicaid in Kansas, he would likely sign the bill.

This is a complete turnabout for Brownback and a thrilling one, indeed.

The governor had publicly expressed strong reservation about expanding Medicaid, which would be linked to Obamacare, or the Affordable Care Act. Under Obamacare, the federal government picks up 100 percent of the costs for the newly insured through 2016, and then reduces the subsidy gradually to 90 percent in 2020.

Kansas currently has one of the most stringent eligibility policies in America. Adults with no children cannot qualify for Medicaid, no matter how little they make. And if they do have children, they can make no more than 26 percent of the federal poverty level, or just more than $5,000 a year for a family of three.

Obamacare sets a different, more lenient threshold. For example, it allows a couple with two children to make up to about $33,000 a year to qualify for Medicaid.

It’s estimated that income difference in Kansas would qualify about 150,000 uninsured people to join up with Medicaid

Likewise, about 300,000 Missourians would be eligible under Obamacare, but despite Democratic Missouri Gov. Jay Nixon pressing hard for expansion, the Republican-controlled legislature has said no.

Brownback, a conservative Republican, is no fan of Obamacare, along with most people in Kansas. But he may be warming up to this one part of the Affordable Care Act.

Many Republican governors have embraced Medicaid expansion. In fact, of the 28 states, plus the District of Columbia, which have expanded Medicaid under Obamacare, nearly half — 13 — have Republican governors.

It is not difficult to make a compelling case for Medicaid expansion. Consider what happens to those who are not eligible.

The uninsured end up either being treated in emergency rooms, or if they land in the hospital, the hospital has to write off most or all of their medical expenses.

That’s why hospitals are pushing for Medicaid expansion. They have been lobbying hard in Kansas as they have in other states.

That may be part of the equation as to why Brownback has opened his mind.

But, hopefully, there is another, more compelling reason.

The current Medicaid program in Kansas — called KanCare — is a cruel policy with guidelines that are way too strict, and Brownback knows it. He knows, too, there are a whole lot of his Kansas constituents who should have health insurance but do not now have it.

Some cynics may think Brownback has an ulterior motive — that expanding Medicaid will somehow help the budget crisis. They are totally mistaken. According to the Kansas Health Institute, a nonpartisan organization, expansion of Medicaid would, if anything, add to the budget beyond 2016, as the federal government starts to reduce its subsidy.

With the unpopularity of Obamacare throughout Kansas, it takes real courage for Brownback to step up and say he would sign a bill to expand Medicaid.

Will the Kansas Legislature also step up and do what is right? Will Kansas lawmakers bring themselves to put aside their distaste for Obamacare to rescue Kansans in need?

Hopefully the answer will be yes.

With Brownback’s tacit blessing of a Medicaid expansion bill to be passed in Kansas, the conservative Republican Legislature may feel obliged to go along.

They respect Brownback. If he hints that he would sign a bill, the Legislature may go ahead and give him one.

And struggling Kansans would be mighty grateful.

To reach Steve Rose, longtime Johnson County columnist, send email to