Some Kansans warm to Medicaid expansion

TOPEKA, Kan. — Legislators and advocates in Kansas pushing to expand the state’s health coverage for the poor to thousands of adults are buoyed by the failure of Republicans in Washington to repeal former President Barack Obama’s signature health care law.

The GOP-controlled Kansas Legislature already was more receptive this year to expanding the state’s Medicaid program, thanks to elections last year that put more moderates and liberals in office. The state Senate was debating a bill Monday and could send it to conservative Republican Gov. Sam Brownback later this week.

Obama’s Patient Protection and Affordable Care Act encouraged states to increase the number of people eligible for Medicaid by promising to pay most of the costs. Some states where Republicans hold power had been reluctant, but 31 states, including some led by GOP governors, have expanded Medicaid. Other states now pursuing expansion include Maine, North Carolina and Virginia.

The effort in Kansas could prove largely symbolic because Republican legislators remain deeply divided and Brownback is a longstanding critic of health care policies championed by Obama, a Democrat. Yet supporters have scored a significant gain by getting a bill so close to passage. Uncertainty about what Congress would do represented a big obstacle.

“That was the most reasonable argument they had against it, and it’s gone,” said Davis Hammet, the president of the progressive Kansas coalition Loud Light, which supports expanding Medicaid.

Kansas’ Medicaid program covers about 377,000 poor, disabled and elderly residents, but poor adults under 65 who aren’t disabled and don’t have children are not eligible. The bill before the state Senate would expand coverage to up to 180,000 of those adults. It passed in the House with a bipartisan majority last month.

The bill makes some concessions to critics. It would require the state to refer new Medicaid participants who aren’t working to job-training programs, and adults must live in Kansas for at least a year to be eligible for the expanded coverage.

Brownback has stopped short of saying he would veto the measure, but in a letter with other GOP governors to congressional leaders last week, he said expanding Medicaid under Obama’s policies moved the program away from its “core mission” of helping the truly vulnerable. Brownback spokesman Melika Willoughby said in an email Monday that it would be irresponsible to “expand ObamaCare when the program is in a death spiral.”

Some Republican lawmakers still argue that the climate in Washington on health care remains uncertain. GOP legislators have long argued that Congress can’t be counted on to keep long-term promises to fund most of the expansion, and the Republican legislation to replace the 2010 Affordable Care Act had a provision that would have blocked an expansion in Kansas.

“We’d be entering into a contract with an unreliable partner,” said state Senate President Susan Wagle, a Republican.

In other states looking at Medicaid expansions, Democratic governors in North Carolina and Virginia are pursuing plans despite opposition from their Republican legislatures. In Maine, a ballot initiative will put the issue to voters in November.

Kansas lawmakers have faced pressure from hospitals and advocates for the poor. Voters last year ousted two dozen of Brownback’s conservative allies from the Legislature, giving Democrats and GOP moderates the clout to at least force a debate.