The effort to expand Medicaid in Kansas has been stuck in the political mud for the better part of three years.
The results of last week’s primary election may have given expansion advocates the traction they need to overcome opposition from Republican Gov. Sam Brownback and legislative conservatives who thus far have blocked debate on the issue.
A series of victories by moderate Republicans over conservative incumbents and challengers for open seats has fundamentally changed the legislative landscape.
“I’ve been working at KHA for 30 years and I’ve never seen this kind of change in one single election,” says Tom Bell, president and chief executive of the Kansas Hospital Association.
Rep. Dan Hawkins, a Wichita Republican who chairs the House Health and Human Services Committee, agrees.
“This was a landslide election,” Hawkins says. “It was a game changer.”
David Jordan, director of the Alliance for a Healthy Kansas coalition, says voters sent a message on a host of issues, including expanding eligibility for Medicaid, which in Kansas is a privatized program known as KanCare.
“They clearly sent a message to the governor and to legislators in Topeka that it’s not acceptable to forfeit $1.9 million a day to Washington by not expanding KanCare,” Jordan says, referring to the amount of federal money the state is forgoing by not expanding the program.
The amount forfeited since January 2014 now totals more than $1.3 billion, according to the hospital association.
The number of legislative seats that will be claimed by moderate Republicans or Democrats who favor expansion have advocates optimistic that they can get a bill through both the House and Senate.
“The fact that we’ve got this many more people in the Legislature, especially the Senate, who want to have the (expansion) discussion is tremendous progress,” Bell says.
Moderate Republicans won eight Senate primaries against more conservative opponents, ousting six incumbents and winning nominations in two seats held by conservatives who are retiring.
Ground also was gained in the 125-seat House, where expansion supporters won at least 15 contests over candidates who opposed expanding KanCare to cover more than 150,000 low-income adults.
Kansas is one of 19 states that have not expanded eligibility for Medicaid.
The annual income limits in states that have expanded Medicaid are $16,242 for an individual and $33,465 for a family of four. In Kansas, non-disabled adults with dependent children are eligible only if their annual incomes are below 28 percent of the poverty level, which for a family of four is $9,216 annually. Pregnant women, children and Kansans who are elderly or disabled are eligible under less restrictive income caps.
Many of the moderate Republicans who defeated more conservative candidates in primaries don’t just support expansion, they’re outspoken on the issue.
Responding to a questionnaire sent by Women for Kansas, a bipartisan advocacy group, Patty Markley, the winner of the Republican primary in Johnson County’s 8th House District, said “it is morally reprehensible that we have not done it.”
Jan Kessinger, the GOP nominee in Johnson County’s 20th House District, also pulled no punches in his response to the questionnaire.
“The refusal of Brownback and the Legislature to accept more than $1 billion of aid is not only fiscally foolish but has taken health care options away from those who are most needy,” Kessinger wrote. “The short-sighted refusal is an example of cutting off one’s nose to spite the face.”
Anita Judd-Jenkins, who defeated six-term incumbent Kasha Kelly for the Republican nomination in the 80th House District, which covers parts of Arkansas City and Wellington in south-central Kansas, made a similar case for expansion in her response.
“Kansas citizens pay federal taxes with the expectation of return of our fair share,” she wrote. “To forfeit our share of our own tax dollars out of protest of the federal program is self-defeating.”
More gains in November
The 14th Senate District in southeast Kansas exemplifies how dramatically the landscape has changed. No matter what happens in the general election, the seat, which is now held by expansion opponent Forrest Knox, will go to an expansion supporter: either Bruce Givens, of El Dorado, who defeated Knox in the Republican primary, or Democrat Mark Pringle, from Yates Center.
The same is true in the neighboring 15th Senate District where the closure of the hospital in Independence has made expansion a potent issue.
Conservative Republican Rep. Virgil Peck, of Tyro, an outspoken opponent of expansion, hoped to claim the seat now held by Senate Vice President Jeff King, who’s retiring. But Peck was defeated by Dan Goddard, of Parsons, who campaigned with the endorsement of the hospital association.
Goddard will face expansion supporter Chuck Schmidt, former superintendent of the Independence school district, in the general election.
Several Democrats who favor expansion also are expected to be competitive in general election legislative races against Republicans who oppose it.
The 25th Senate District in Wichita is considered a swing district, meaning candidates from either party can win it. Expansion advocates are banking on Democrat Lynn Rogers, a 15-year veteran of the Wichita Board of Education. He’s facing GOP primary winner Jim Price, whom the Wichita Eagle describes as a “libertarian-minded defense contractor … who has had two criminal convictions, a bankruptcy and other legal problems.”
The winner will replace Republican Michael O’ Donnell, an expansion opponent, who is running for the Sedgwick County Commission.
Expansion advocates also see the swing-district race in Pittsburg between Democrat Monica Murnan and first-term Republican Rep. Charles Smith as a chance to pick up a vote.
In her response to the Women for Kansas questionnaire on expansion, Murnan, a Pittsburg city commissioner, said the state’s rejection of expansion is “hurting individual people” and “putting an unnecessary burden on our local providers and hospitals.”
Brownback still opposed
Hawkins, the chairman of the House health committee, remains “skeptical” of expansion, saying the state can’t afford its share of the costs due to its ongoing budget problems. Still, he believes expansion advocates will have enough votes to pass a plan.
“The coalition that could be put together with some Republicans and some Democrats, I think they can control that issue now,” Hawkins says.
But passing an expansion plan and getting it signed into law are two different things. Hawkins says the governor’s opposition remains “pretty solid.”
Eileen Hawley, a spokesperson for Brownback, confirmed that in an email.
“The Governor has the same concerns about expanding Obamacare today as he clearly articulated to the voters of Kansas prior to his re-election two years ago,” Hawley says.
Those concerns range from the cost of expanding KanCare to low-income non-disabled adults before all Kansans with disabilities are receiving Medicaid support services in addition to their medical benefits.
Asked whether the governor would veto an expansion bill if lawmakers sent one to his desk, Hawley says, “We are not going to comment on signing a piece of legislation that has not even been written.”
Jim McLean is executive editor of KHI News Service in Topeka, a partner in the Heartland Health Monitor team.