Guest Commentary

How did Kansas Medicaid expansion die? Here’s the view from inside the House

Conservative Republican leaders in the Kansas House and Senate frequently, and deservedly, get blamed for blocking Medicaid expansion in the state. But how do just a few people wield so much power that they can stifle policy supported by Kansans, other legislators and Gov. Laura Kelly? The answer is as obvious as it is unpleasant: We let them. Or rather, the members of their Republican caucuses let them.

Yes, the speaker of the House and Senate president appoint committee chairs and can revoke them. Majority leaders in each chamber can control what bills come up for votes — or don’t. These powers are significant obstacles, and you have heard many complaints about them from pro-expansion legislators, myself included. They are not, however, insurmountable barriers. At the end of the day, the real power lies with majorities of lawmakers.

If the 70 representatives and 24 senators who support Medicaid expansion cared more about helping Kansans receive affordable health care than their re-election or their chairmanships, we would have passed the measure. And maybe, in addition to health care for 150,000 Kansans (as well as an economic boost), we could have given Kansans a reason to be less cynical about our politics.

For a brief few hours last Friday and Saturday, it looked like the impossible just might happen. A coalition of 23 Republicans and every Democrat in the House voted to send a budget bill back to committee. The budget itself was great (thank you, Gov. Kelly), but passing it meant losing the opportunity to pass Medicaid expansion this year. To this Democrat at least, it looked as if the commonsense majority was finally willing to put good policy ahead of personal interests and partisanship.

Side note: As a Kansas House Democrat, you don’t spend most of your time dreaming about defeating Republicans, but rather getting them to stand with you for what you all know is right (and when they don’t, then we dream about beating them).

The speaker and majority leader reacted, predictably and recklessly, with vengeful budget cuts. If they thought their partisan temper tantrum would be well received by the Republicans in the Medicaid expansion coalition, they were mistaken. The revenge budget was rejected soundly with over 80 no votes and some powerful speeches by Republicans against their own leadership.

With that strong rebuke to the bullying, many of us left Friday relieved to finally see a bipartisan majority flex its muscles for the good of Kansas again. So long as the coalition held together, we held the leverage to demand a vote on Medicaid expansion in the Senate — which would have passed and been sent to the governor for her signature.

We came in Saturday to hours of delay by the speaker and his allies. Though the waiting meant only that GOP leadership had not yet broken down the bipartisan coalition, we continued to hear some of the expansion-supporting Republican legislators were getting shaky. Fellow Republicans, our Democratic representatives and the governor herself worked tirelessly to reassure the uncertain members that together we held the power, and that Medicaid expansion was worth the effort. It seemed each minute brought alternating reports of confidence or imminent collapse of the Republican portion of our coalition.

Finally, we were brought the newest budget: This one eliminated a child welfare oversight committee and burdened the Department of Corrections with bureaucratic barriers to addressing our prison emergencies. When the votes went up, it was immediately clear that many in our coalition had caved. After holding the vote open to twist arms, GOP leadership rounded up the final votes needed to pass this budget and crush Medicaid expansion for the year.

After a majority voted yes for the budget, the rest of the Republicans in the coalition, except state Rep. Diana Dierks, switched to join the “winning” side.

In the end, health care for Kansans took a back seat to Republican partisan loyalty and personal political interests. For a fleeting moment, the Kansas House functioned as it was meant to, only to come crashing back to a reality that justifies even the harshest cynicism about politics.

Kansas lost. Medicaid expansion failed. Not because of its opponents, but because its own supporters made the conscious decision to allow it to die, alongside the faith of so many Kansans.

Overland Park Democrat Brett Parker represents District 29 in the Kansas House of Representatives.