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Hopes Dimming For Medicaid Expansion In Kansas

Andy Marso
Heartland Health Monitor

The chairman of a Kansas House committee holding three Medicaid expansion bills says he has no current plans to have hearings on any of the proposals.

“At this time I haven’t scheduled anything,” said Rep. Dan Hawkins, a Wichita Republican and chairman of the House Health and Human Services Committee. “Will I schedule something? I can’t say right now. But right now there is nothing scheduled.”

Hawkins is in his first year as chairman of the health committee. His predecessor, former Rep. David Crum, an Augusta Republican, refused to hold hearings on expansion proposals in 2013 and 2014. Expansion advocates, most notably the Kansas Hospital Association, hoped that Hawkins would allow hearings even though he opposes both the Affordable Care Act and the Medicaid expansion it authorizes and helps to fund.

Rep. Don Hill, a Republican from Emporia, is the sponsor of one of the Medicaid expansion bills. It would repeal language added to a budget bill in 2013 that prohibits Gov. Sam Brownback from crafting an expansion plan and negotiating its approval with federal officials.

Hill, a retired pharmacist, has been working behind the scenes for several weeks to convince Brownback and Republican legislative leaders to consider a Kansas version of Medicaid expansion plans being pursued by Republican governors inIndiana, Tennessee, Wyoming and several other conservative-leaning states. Those plans use federal Medicaid funds to help purchase private coverage for low-income adults. Many also require recipients to share in their health care costs in ways that traditional Medicaid doesn’t.

Hill said discussions with Brownback and members of his staff are continuing. But he said his most recent conversation with Hawkins wasn’t promising.

“The indication at this point is that Chairman Hawkins is not inclined to hold hearings,” Hill said.

Asked why he opposed expansion, Hawkins said: “I’m really not for government-sponsored health care.”

He said the cost of expansion concerns him even though the Affordable Care Act commits the federal government to pay 100 percent of the costs through 2017 and not less than 90 percent thereafter.

A study commissioned by the Kansas Hospital Association estimated expansion would cost the state anadditional $312 million through 2020. But the same study said that savings and tax revenues resulting from expansion would more than offset that cost.

In addition, hospital officials, who need Medicaid expansion to offset reductions in Medicare reimbursements, have said they’re willing to discuss increasing a state assessment on their revenues to help pay for it.

Beyond the issue of cost, Hawkins, like other conservatives, said he is opposed to providing taxpayer-funded coverage to non-disabled adults even if they can’t afford private insurance.

“I always tried to find a job that had health care,” he said when asked what poor Kansans needing coverage should do. “I’ve always worked, and I’ve always had a job that paid for health care or paid a portion of it.”

Kansas’ privatized Medicaid program, KanCare, covers about 425,000 children and low-income, disabled and elderly adults. But that number includes relatively few able-bodied adults.

Adults with dependent children can participate in KanCare, but only if they have incomes below 33 percent of the federal poverty level, $7,770 annually for a family of four. Adults without children aren’t eligible for coverage no matter how poor they are.

Expansion would make all Kansans with incomes up to 138 percent of poverty eligible for KanCare. The eligibility cap would be set at annual income of $16,105 for an individual and $32,913 for a family of four.

Without hearings and a vote in the health committee, it will be difficult for expansion advocates to get a bill to the House floor for a vote. But if that were to happen, Hill said, he believes an expansion bill could pass.

“It very well might be a close vote,” Hill said. “But I think there is a lot of bipartisan support for Medicaid expansion in the Legislature and in the House in particular.”

Jim McLean is executive editor of KHI News Service in Topeka, a partner in the Heartland Health Monitor team.

Jim McLean is a political correspondent for the Kansas News Service, a collaboration based at KCUR with other public media stations across Kansas. You can email him at jim@kcur.org.
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