If elections have consequences, the top-of-the-ticket win for Democrats in Kansas likely carries no more obvious upshot than the probable expansion of Medicaid in the state.
After years of unyielding opposition from former Republican Gov. Sam Brownback and his successor — Gov. Jeff Colyer — Democratic Gov.-elect Laura Kelly looks positioned to broaden public health insurance coverage to tens of thousands more Kansans.
Kelly campaigned on expansion and listed it among her priorities in an election night victory speech.
“It’s long past time to expand Medicaid so that more Kansans have access to affordable health care,” Kelly said to cheers from supporters.
Kelly, a veteran state senator from Topeka, defeated Kansas Secretary of State Kris Kobach. A conservative Republican, he opposed expansion with at least as much vigor as Brownback and Colyer.
Kelly’s decisive five-point win has made longtime advocates of expansion optimistic that they can get it signed into law during the 2019 legislative session, which begins Jan. 14.
“We’re hopeful,” said Tom Bell, president and CEO of the Kansas Hospital Association. “But we’re also not taking anything for granted.”
Bell and other supporters fear that the defeat of some moderate Republicans by conservatives may have softened support for expansion in the Kansas House. However, with Kelly in the governor’s office, they would no longer need a veto-proof majority.
The Legislature approved expansion in 2017, but Brownback vetoed the bill.
Advocates can’t take it for granted that expansion is “automatically going to happen,” Bell said, “but bottom line, we’re much more encouraged than we have been the last few years.”
Some Republican legislative leaders who have spearheaded opposition to expansion appear ready to move on.
Rep. Dan Hawkins, the Wichita Republican who chairs the House Health and Human Services Committee, recently told the Wichita Eagle that expansion is a “foregone conclusion.”
Republican lawmakers shouldn’t waste energy opposing expansion, said Jim Joice, executive director of the Kansas Republican Party.
“I’m not sure if that (opposition) would be the best political strategy, if that’s the hill you want to die on this year,” Joice said.
The priority for Republicans should be holding Kelly to her pledge to balance the budget, fund schools, re-start the highway program and expand Medicaid without a tax increase, Joice said.
Currently, eligibility for KanCare, Kansas’ privatized Medicaid program is limited to children, pregnant women, people with disabilities and seniors in need of long-term care who have exhausted their financial resources. Parents are eligible only if they earn less than a third of the federal poverty level, less than $10,000 for a four-person family.
Single adults without children currently are not eligible no matter their income.
Expansion would extend eligibility to all Kansans who earn up to 138 percent of the poverty level, or about $17,000 annually for an individual and approximately $34,000 for a family of four.
In addition to extending coverage to an estimated 150,000 low-income Kansans who are now not eligible for KanCare, expansion would draw billions in additional federal funding. Advocates say that would help struggling hospitals across the state, many in rural areas.
“Medicaid expansion would certainly help them,” said Bell, noting that higher Medicaid reimbursements would help cover some of the losses caused by reductions in Medicare payments.
The Affordable Care Act requires the federal government cover 90 percent of the cost of expansion. The state’s costs would increase by an estimated $68 million a year, according to an estimate compiled by the Kansas Health Institute.
Expansion opponents insist the price tag will be much higher, but supporters contend it could be implemented at relatively little additional cost if federal dollars are used to cover services now funded with state dollars.
Jim McLean is managing director of the Kansas News Service, a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio covering health, education and politics. You can reach him on Twitter @jmcleanks.
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