Medicaid expansion stirs debate in Kansas
TOPEKA, Kan. — Democratic Gov. Laura Kelly is more aggressive and openly political in pushing to expand Medicaid in Kansas as the Republican-controlled Legislature prepares to open its annual session Monday following five years of failed efforts to provide state health coverage to another 150,000 people.
Kelly faces leaders of GOP supermajorities whose priorities are to cut income taxes and rein in local property taxes, not to expand Medicaid.
But Kelly’s new plan includes hitting expansion-opposing Republicans hard later this year during races for legislative seats, an approach that cuts against years of self-branding as a bipartisan problem-solver who doesn’t care about politics.
“My previous approach, which has always been to try to bring people together and work collaboratively and come up with consensus and then get good policy on the books — that hasn’t worked,” Kelly said during a recent interview.
“Taking a more aggressive approach and — to be direct, a more political approach to it — might be the answer,” she added.
For months, Kelly has toured the state for news conferences and roundtables to build support for Medicaid expansion. She said she modeled her campaign on one by Democratic Gov. Roy Cooper in North Carolina, where a GOP-dominated legislature expanded coverage as of Dec. 1.
Kansas is among only 10 states that have not expanded Medicaid in line with the 2010 federal Affordable Care Act, which promises federal funds to cover 90% of the new costs. In two other states, Georgia and Mississippi, top Republicans have signaled willingness to discuss expansion this year so the issue isn’t a dead letter.
In Kansas, conservative opposition is rooted in small-government beliefs and decades of skepticism about social services. In the fall, House Speaker Dan Hawkins and Senate President Ty Masterson, both Wichita-area Republicans, derided Kelly’s events with business leaders, hospital administrators and health advocates as a “Welfare Express Tour” for “more government dependency.”
“It’s about not using taxpayer dollars to fund free healthcare for a new population of able-bodied childless adults who don’t want to work,” Hawkins said in an email.
To attract GOP votes, Kelly has mandated that those who would newly qualify for Medicaid verify annually they are working. But Masterson told reporters, “It really doesn’t change the underlying facts.”
In Kansas, childless adults without disabilities don’t qualify for Medicaid. Some parents aren’t covered when their household incomes hit 38% of the federal poverty level. For a single parent of one child, it’s less than $7,500; for a family of four, it’s $11,400.
An expansion would make both groups eligible if they earn up to 138% of the federal poverty level. A single, childless adult could earn $20,100; a single parent and one child, about $27,200; and a family of four, $41,400.
Of the people who would qualify, 73% are in families with at least one full- or part-time worker, according to KFF, the research organization formerly known as the Kaiser Family Foundation. Many work in services and others are independent contractors, said Sean Gatewood, a former Kansas House member and spokesperson for the KanCare Advocates Network, a pro-expansion coalition.
Kelly’s plan would increase the cost of the Kansas Medicaid program by 31%, about $1.35 billion a year. However, federal funds would cover all but $135 million, with the state imposing fees on hospitals and large private health insurance companies for most of the rest.