Legislators locked in increasingly tense discussions about how to balance the budget and end the longest legislative session in Kansas history said there is no longer any serious talk about expanding Medicaid eligibility this year.
“Given all the time we’ve wasted, it is incredibly disappointing that we couldn’t find the time to deal with this issue,” said Rep. Jim Ward, a Wichita Democrat and the Legislature’s most vocal advocate of expansion.
Currently, non-disabled adults without children aren’t eligible for the state’s Medicaid program, called KanCare, no matter how poor they are.
Expansion would make all Kansas adults with incomes up to 138 percent of poverty eligible. That’s $16,105 in annual income for an individual and $32,913 for a family of four.
The U.S. Census Bureau estimates that 324,000 Kansans age 19 to 64 have incomes that would qualify them for coverage under expansion. Of those, about 131,000 are uninsured.
For the third consecutive session, what appears to be a powerful coalition led by Kansas hospitals has failed to gain traction on the issue due in large part to its connection to the Affordable Care Act, which many Republicans who control the Legislature continue to oppose.
GOP leaders blocked hearings on expansion during the 2012 and 2013 sessions. They allowed a hearing this year, but only to prevent expansion supporters from forcing a surprise vote on the House floor.
‘The problem at hand right now’
Rep. Susan Concannon, a Beloit Republican and vice chair of the health committee, said that while the expansion issue deserves more consideration, it has been overtaken by circumstances. The budget and tax negotiations already are difficult and contentious. Adding Medicaid expansion to the mix would make it even harder to reach consensus on a plan to end the session.
“We want to just take care of the problem at hand right now and make sure that we don’t have to furlough state employees and that we fill this budget hole that we have,” Concannon said.
That may be the mindset of most legislators, but it hasn’t prevented several contentious issues from becoming part of the tax and budget negotiations. Proposals to impose what amounts to a lid on local property taxes, repeal hundreds of millions of dollars in sales tax exemptions and provide tax credits to business that fund private school scholarships have been included in tax packages negotiated by a House-Senate conference committee.
Rep. Tom Sloan, a Lawrence Republican, is one of the few legislators still urging consideration of an expansion plan this session. He provided legislative leaders with an updated version of the Medicaid expansion plan developed by the Vision 2020 Committee, which he chairs. It would impose fees on a wide range of health providers to generate the state’s $68 million annual cost of expansion and provide $39.1 million to help balance the fiscal year 2016 budget.
A week ago, Sloan said the plan was being discussed.
“It has not been dismissed out of hand,” he said.
But Concannon said the proposal quickly ran into opposition from the expansion supporters it was designed to appease because of the assessments it would have imposed on doctors, chiropractors, podiatrists, pharmacists, optometrists, nursing homes, hospitals and mental health providers.
“I don’t think it’s a good idea to tax the very people who are providing the Medicaid care,” she said. “We have a hard enough time getting providers to participate in the Medicaid program.”
Polls find support for expansion
Cindy Samuelson, a spokesperson for the Kansas Hospital Association, said that while the organization appreciated Sloan’s efforts to keep the issue alive, “We continue to stand by our study that expansion pays for itself.”
The hospital association’s study estimated that expansion by 2016 would cost the state an additional $312 million over the next five years. But it also said that savings in other programs and tax revenue from jobs and economic activity associated with expansion would more than offset the additional cost to the state.
In addition to funding studies that document the economic benefits of expansion, KHA has funded several statewide polls, each of which has found strong bipartisan support for it. The most recent poll, conducted in April by a firm that predominately works for Republican candidates, showed that 64 percent of likely Kansas voters supported expanded Medicaid eligibility, including 58 percent of the Republicans surveyed.
Support climbed to 69 percent when respondents were told that expansion would attract more than $2 billion in additional federal funding to the state. And it remained at 58 percent when the surveyors asked a series of questions that made it clear that expansion was connected to Obamacare.
“We were pleased to see that even using this language, Kansans overwhelmingly still supported KanCare expansion,” Samuelson said.
Rep. Dan Hawkins, a Wichita Republican who chairs the House health committee, said the Kansans who responded to the survey don’t have access to all the information that he and other legislators have about the state budget and the cost of Medicaid expansion. Based on that information, Hawkins said he isn’t convinced that the costs of expansion would be as manageable as the hospital association and other supporters claim.
“It’s not the connection to Obamacare. For me, it’s really the cost,” Hawkins said, explaining that he believes the cost of expansion would be much higher than the hospital association estimates, more in the range of $125 million a year.
“We’re in a fiscal nightmare here,” Hawkins said, referring to the Legislature’s ongoing struggle to agree on a tax plan to raise the roughly $400 million necessary to balance the 2016 budget. “Adding that (expansion) would just compound things even more.”
Samuelson said hospitals will continue to lobby for KanCare expansion until the gavel falls on the session. But, she said, “In the unfortunate event that expansion does not occur this session, the hospital community will continue to push forward and explore options to develop a Kansas solution that will meet with the Legislature’s approval.”
Jim McLean is executive editor of KHI News Service in Topeka, a partner in the Heartland Health Monitor team.
