Update Thursday, 11:23 a.m.: In final action, House Bill 2064 passed the House 81-44. It now goes on to the Senate.
Supporters of expanding Medicaid eligibility to more low-income Kansans succeeded Wednesday in a last-gasp effort to advance a bill, overpowering opponents who thought they had blocked it earlier in the week.
The Kansas House voted 85-40 to amend the contents of the expansion bill — House Bill 2064 — into a measure that would allow some community-based mental health programs to bill Medicaid for their services.
The amendment was necessary because opponents on the House Health and Human Services Committee blocked an effort Monday to move the expansion bill onto the House floor, prevailing by a single vote.
Wednesday’s vote was the first on Medicaid expansion in the House or Senate since the U.S. Supreme Court ruled in 2012 that it was optional for states.
Rep. Susan Concannon, a Beloit Republican, spearheaded the rescue effort, reminding House members that the state’s rejection of expansion has cost Kansas an estimated $1.7 billion in additional federal funds over the last three years.
“We have left that [money] on the table,” Concannon said.
Expansion supporters hailed the vote.
“Today, the majority of the House of Representatives voted to bring our money back to Kansas to create jobs, to protect our hospitals and providers and, most importantly, to improve the health of 150,000 Kansans,” said David Jordan, executive director of the Alliance for a Healthy Kansas, a nonprofit advocacy group created to lobby for expansion.
The expansion bill would broaden eligibility for the state’s privatized Medicaid program to approximately 300,000 low-income Kansans with annual incomes at or below 138 percent of the federal poverty level, or about $16,000 for an individual, according to the Kansas Health Institute.
However, for a variety of reasons, only between 150,000 and 180,000 would initially enroll, according to estimates by KHI and the Kansas Department of Health and Environment, the state agency that oversees Medicaid, which in Kansas is a privatized program known as KanCare.
In a debate that went on for more than two hours, supporters and opponents traded arguments for and against expansion.
Rep. Jim Kelly, a Republican from Independence, said the state’s rejection of expansion contributed to the closing of the only hospital in the southeast Kansas community.
“Think if your town was Independence, Kansas, and you were living not the dream but the nightmare of a hospital closing,” Kelly said. “I would urge you to support this amendment for expansion because the next time it happens it could be in your district.”
Rep. John Eplee, a Republican from Atchison and a family physician, said he wanted to “put a real live face” on the issue by talking about three of his patients, two of whom died because they waited too long to seek care. All, he said, were non-disabled adults who worked but could not afford private health insurance.
“They are indeed able-bodied, hard-working people that we have turned our backs on,” Eplee said. “This is our opportunity to change that.”
Rep. John Whitmer, a Wichita Republican, argued that expansion would worsen the state’s persistent budget problems. He pointed to the fact that enrollment greatly exceeded expectations in many of the 31 states that have expanded Medicaid.
“Unless y’all want to vote for another tax increase, that’s relevant information you should consider,” Whitmer said.
Rep. Eric Smith, a Republican from Burlington, said it would be financially risky for the state to proceed with expansion with President Donald Trump and Republicans in Congress poised to repeal the Affordable Care Act. If that happens, he said, the billions of federal dollars that expansion supporters are counting on would disappear.
“I’m not asking you what you’re going to go home and tell your constituents today, I’m asking you what you’re going to tell them in two years, three years or four years down the road when this fails,” Smith said.
Responding to the cost arguments, Rep. Cindy Holscher, an Overland Park Democrat, noted that governors in many of the states cited by Whitmer are lobbying to keep expansion because “they’re not over budget, they’re over enrollment.”
“That’s a key difference,” she said, noting that states have so far used mostly federal funds to cover the additional costs.
Holscher also noted a new argument for expansion, claiming that it would help prevent “medical divorces.”
“Yes, that’s a thing now,” she said, explaining that a recent University of Kansas study indicated that fewer couples are getting divorced in expansion states because they no longer have to spend down their assets to qualify for Medicaid when one spouse suffers a debilitating illness.
“People: Couples are getting divorces in order to obtain health care,” she said. “I would suggest to you that Medicaid expansion is pro-family.”
A recent poll conducted by the American Cancer Society Cancer Action Network indicated that 82 percent of Kansas voters support expansion.
Jim McLean is managing director of KMUW's Kansas News Service, a collaboration of KMUW, Kansas Public Radio and KCUR covering health, education and politics in Kansas. Follow him on Twitter @jmcleanks.
