Kansas Democratic Gov. Laura Kelly’s Medicaid expansion proposal is a retread.
It’s virtually the same bill that former Republican Gov. Sam Brownback vetoed in 2017.
An attempt to override that veto in the House failed, but only by three votes.
A bipartisan working group appointed by Kelly to provide input met once and decided against making any major changes.
In a statement Tuesday announcing the release of her bill, Kelly said it was “long past time” to expand eligibility for KanCare, the state’s privatized Medicaid program. The proposal would provide health coverage to an additional 150,000 low-income, disabled, and elderly Kansans starting in January of 2020.
Kelly said her expansion plan would also help save rural hospitals and reclaim billions of federal tax dollars.
Expansion opponents contend it would do little to help the state’s struggling rural hospitals, arguing they are much more dependent on Medicare, the federal healthcare program for people over 65.
While it’s true that Medicare revenue is critical, many rural hospital administrators say that expanding Medicaid would also boost their bottom lines.
“For my hospital, it means about another $3 million a year, which is a margin that I don’t have right now,” said Dennis Franks, the hospital CEO in Chanute, a small community in the southeast corner of the state.
The Kansas Hospital Association and the Alliance For A Health Kansas, a coalition advocating for expansion, quickly issued statements supporting the governor’s proposal.
The hospital association, which has spearheaded the lobbying effort for expansion for several years, said the bill is based on “what has worked in other states and what makes sense for our state.”
Kansas is one of only 14 states that hasn’t expanded Medicaid to include people who make under 138 percent of the federal poverty level — roughly $17,000 for a single person and $35,000 for a family of four.
Cost an issue
The governor proposed adding $14 million to next year’s budget to cover the state’s share of expansion costs for the first six months. Annual costs in subsequent years would be roughly double that amount.
Expansion opponents insist the cost would be much higher.
“You missed it by a whole decimal point. Totally impossible,” said Senate Majority Leader Jim Denning during a recent briefing by Larry Campbell, Kelly’s budget director.
The Affordable Care Act requires that the federal government shoulder 90 percent of expansion costs.
That commitment, opponents say, is unreliable. At some point, they insist, Congress will retreat from it.
To address that concern, Kelly’s bill includes an out clause. It gives the state’s health agency authority to terminate the program if the federal match rate ever dips below 90 percent.
Work requirements too
Under the governor’s proposal, the state health department would have to refer KanCare recipients who are either unemployed or working fewer than 20-hours a week to a “workforce development” program.
But that falls short of the work requirement that many Republicans say must be included for them to consider the bill.
“I think if somebody said ‘Laura Kelly will not support work requirements at all, period, don’t even try it.’ I think people would say, ‘Well, we’re not going to work it (the bill),’” said Republican Gene Suellentrop, chair of the Senate health committee.
Suellentrop and other Republicans want language added to the bill that would require recipients to have a job or be participating in job training to be eligible for coverage.
House health committee chair, Republican Rep. Brenda Landwehr, said she won’t hold hearings on the governor’s bill. Instead, she is planning several days of roundtable discussions about “the issue of Medicaid expansion.”
“If I ask five people, what’s Medicaid expansion, I’ll get five different answers,” Landwehr said. “Let’s get the facts out on the table.”
Organizing the meetings will take until mid-February, Landwehr said. It could then take weeks to complete them.
“If it takes two weeks, that’s what I’ll do,” she said.
Democrats backing Kelly's proposal say that any attempt by Republican leaders to delay or block a vote on it could cost them with voters.
“I think there’s a lot of political risk (for them),” said Senate Minority Leader Anthony Hensley. “It was an important issue in the … gubernatorial campaign. I think it’s something the people of Kansas believe the Legislature should do.”
Jim McLean is the senior correspondent for 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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