KANSAS Medicaid expansion sails.

GOP-led Senate OKs it 25-14, but governor’s veto awaits

TOPEKA, Kan. — Days after the failure of the Republican health bill in Washington, lawmakers in GOP-controlled Kansas voted to participate in a key part of the law it was meant to replace.

The Kansas state Senate voted 25 to 14 Tuesday to expand Medicaid — the state-federal program for the poor — extending eligibility to about 150,000 additional low-income people. The measure, which passed the House last week, succeeded with the support of all the Democrats in the Legislature, as well as a number of newly elected moderate Republicans who campaigned on a promise to broaden the program.

Gov. Sam Brownback, a Republican, is widely expected to reject the measure, however, and the Legislature was shy of mustering the twothirds vote necessary to override a veto.

Coming on the heels of the failure of the Republican plan to repeal and replace the Patient Protection and Affordable Care Act, the vote sent a strong signal that Republicans nationally are facing new pressure to participate in a program that they once saw as one of the law’s central evils.

Sen. Vicki Schmidt, a Republican sponsor of the Kansas bill, said the failure last week of the Republicans’ American Health Care Act signaled that Congress is not going to come up with a better alternative.

“I don’t believe we can wait for D.C.,” she said during a floor debate on the measure Monday. “They had an opportunity … and they didn’t take it.”

The measure passed in part on a desire to prop up financially struggling community hospitals. One hospital in the town of Independence had already shuttered because of a shortage of paying patients, and the Kansas Hospital Association, which supported the bill, had warned that others might be forced to follow suit.

Republican critics of the bill said they are sympathetic to the hospitals but reluctant to join a program that they think is flawed.

“I care about my hospitals,” Republican state Sen. Susan Wagle said, growing emotional. “But this is a broken program. It’s a broken program, people.”

While Brownback has not said explicitly that he will veto the measure, he issued a statement Monday reiterating his past objections.

“To expand Obamacare when the program is in a death spiral is not responsible policy,” spokesman Melika Willoughby said in a statement. “Kansas must prioritize the care and service of vulnerable Kansans, addressing their health care needs in a sustainable way, not expanding a failing entitlement program to able-bodied adults.”

Since the passage of the Affordable Care Act, 30 states and the District of Columbia have opted to participate in the Medicaid expansion, according to the nonpartisan Kaiser Family Foundation. It is the primary mechanism by which the law extended health coverage to very-lowincome adults who were previously ineligible.

Sixteen of those states were GOP-led. Nineteen others, including Kansas, rejected the expansion because of the burden it put on states and a hope that Republicans in Washington would ultimately repeal the Affordable Care Act.

There are signs that more states might try to follow Kansas’s lead. On Monday, Virginia Gov. Terry McAuliffe, a Democrat, pledged to press anew for his state to expand Medicaid in light of the failure of the Republican alternative to the Affordable Care Act, even in the face of strong Republican opposition to the expansion. Georgia Gov. Nathan Deal, a Republican, also said his state will explore changes to the Medicaid program.

In Congress, House Speaker Paul Ryan has pledged to return to the blackboard to try again to repeal and replace the law as lawmakers work on other aspects of President Donald Trump’s agenda.