Kansas lawmakers and governors have been arguing about Medicaid expansion for nearly a decade. But as Jim McLean of the Kansas News Service reports, expansion advocates could be on their way to winning that fight.
What had to happen to end the standoff on expansion, finally happened.
The key players at the center of the fight – Democratic Governor Laura Kelly and Senate Republican Majority Leader Jim Denning – worked out a compromise that gave both sides some of what they wanted.
“Compromise is hard. It is messy and it’s slow. But it is so worth it,” Kelly said at a Statehouse news conference.
With the stakes so high, and politics so polarized these days, any deal is fragile. But Denning expects this one to hold.
“That’s what governing is all about,” Denning said when announcing the deal. “Somebody has to lead and we have to get to ‘yes’ and we have to govern and I think that’s what this bill accomplishes.”
A majority of senators - an equal number of Republicans and Democrats - have signed on as co-sponsors of the bill. But many Republicans - including several in leadership positions - still oppose expansion in any form.
“It’s not very popular where I’m at,” said Sen. Richard Hilderbrand from Galena. “I can tell you most people do not want Medicaid expansion.”
If passed and signed into law, the plan backed by Denning and the governor would extend health coverage to an estimated 130,000 thousand more low-income Kansans. That includes people like Geneva Gary of Pittsburg. She’s uninsured and needs back surgery.
“It needs to be taken care of because it interferes with the way I walk and sometimes if I stand too long it bothers me,” she said.
Gary isn’t eligible for Medicaid now because her back injury isn’t severe enough to classify her as disabled.
Situations like the one Gary faces have been at the heart of the expansion debate for years.
When he was governor, Republican Sam Brownback said non-disabled adults should work and fend for themselves, not depend on taxpayers for health coverage.
“That is a far more likely route out of poverty than having a bunch of government programs that you’re giving handouts to able-bodied individuals,” Brownback said when he was in office.
Brownback vetoed an expansion bill in 2017 and failed to override him. But the politics of expansion shifted the very next year.
“It’s long past time to expand Medicaid,” Kelly said on the night she won the governorship.
For expansion supporters like the Kansas Hospital Association’s Tom Bell, Kelly’s win in the governor’s race was a game changer.
“It changes the landscape dramatically because you have a governor who will not only sign a bill but who actually will be pushing for Medicaid expansion,” Bell said.
Kelly pushed, but Republican leaders in the Senate continued to resist last year, including Denning.
Republicans blocked a decisive vote on expansion at the end of last year’s session. But Kelly said Denning made good on his promise to work on a compromise for lawmakers to consider this year.
“Senator Denning and I did not end the 2019 legislative session on particularly friendly terms, but we kept at it,” she said. “We kept talking.”
The plan they negotiated includes a work referral program, not the work requirement that Republicans wanted.
But at Denning’s insistence, it includes a program to lower the cost of private coverage on the Affordable Care Act - or Obamacare - exchange. The subsidies are aimed at helping Kansans who would still make a little too much for Medicaid.
“They’re getting priced out of the market because they simply can’t handle those premiums anymore,” Denning said. “So, the ACA exchange is creating a whole new universe of uninsured patients that are basically middle class.”
The federal government would cover nearly all of the cost of expansion - 90 percent of it. Most of state’s share -- about $35 million a year -- would come from a new tax on Kansas hospitals.
Hospitals that would benefit from a flood of new federal dollars flowing into the state to insure people who today lack coverage.