Updated Tuesday at 10:41 a.m.
Buoyed by the failure of Republicans in Congress to repeal the Affordable Care Act, the Kansas Senate on Tuesday gave final approval to a Medicaid expansion bill in a 25-14 vote.
The bill now goes to Republican Gov. Sam Brownback, whose spokeswoman reaffirmed his opposition to expansion in tweets during a debate Monday night but did not say whether he would veto it.
Read HB 2044 here.
The full Senate debated the bill for 3 hours Monday night before a bipartisan group of 25 senators voted in favor of advancing the bill to a final vote. All 13 “no” votes were cast by Republicans concerned about the cost of expansion and opposed to providing coverage to low-income, non-disabled adults.
In a statement released minutes after Monday's vote, David Jordan, director of the Alliance for a Healthy Kansas, a coalition of health care providers and other organizations that support expansion, urged the governor to “join with the overwhelming bipartisan majorities” that approved the measure in the Kansas House and Senate by signing the bill.
The House passed the expansion bill 81-44 in late February.
If Brownback does veto the measure, supporters would need three more votes in the House and two in the Senate to override him.
We must prioritize care of vulnerable Kansans, not expand a failing entitlement program for able-bodied adults #ksleg pic.twitter.com/TDV4AisRNx
— Melika Willoughby McKinnis (@MelikaMaria) March 27, 2017
House Minority Leader Jim Ward, a Wichita Democrat, is optimistic that supporters could round up the votes.
“I absolutely think there are 84 votes in the Kansas House to override the governor if he should veto Medicaid expansion,” Ward said. “The vote count is closer in the Senate obviously, but I think we’ll get there.”
As long as the ACA remains in place, the federal government is obligated to cover no less than 90 percent of the cost of expansion.
Those federal dollars are a big reason why 31 states and the District of Columbia — including several headed by Republican governors — have expanded eligibility for their programs. The AP reports other states, including Maine, Virginia and North Carolina, are now pursuing expansion. Kansas and Missouri are among 19 states that have so far rejected expansion.
Though congressional leaders have shelved the ACA replacement bill, it’s not clear whether additional states will be allowed to expand their programs by a Trump administration that remains committed to dismantling the health reform law.
Setting aside potential barriers to its implementation, expansion would greatly increase the number of Kansans eligible for KanCare, the state’s privatized Medicaid program.
Eligibility is now limited to children and pregnant women in low-income families, people with developmental and physical disabilities, and seniors who cannot afford nursing home care. Parents are eligible only if they earn less than a third of the federal poverty level, or about $9,200 annually for a four-person family.
Single adults without children aren’t eligible for coverage no matter their income.
Expansion would broaden eligibility to all Kansans earning up to 138 percent of the federal poverty level, annually $16,642 for individuals and $33,465 for a family of four.
An estimated 300,000 Kansans would qualify for coverage under expansion, though only about half that number would enroll in the first year, according to estimates.
Opponents argued expansion is unaffordable despite estimates compiled by the Kansas Hospital Association indicating it would generate enough revenue and savings to cover the state’s share of the cost. And, they said, it’s just a matter of time until the ACA is repealed.
“We’re standing at an amusement park ride that’s closed,” said Sen. Ty Masterson, a conservative Republican from Andover. “It’s broken and we’re saying we want to go ahead and get on the ride.”
But when pressed by expansion opponents, Sen. Vicki Schmidt, a moderate Republican from Topeka, said she has confidence in the KHA estimates, which predict expansion would benefit the state budget to the tune of approximately $70 million.
“I believe that there are assumptions made, but I believe that the assumptions are good,” Schmidt said.
Sen. Barbara Bollier said while cost is an important issue, the health care that expansion would provide to tens of thousands of uninsured Kansans was the most important consideration for her.
“It’s very easy for us to sit in these seats and look at a graph, or look at a statistical analysis, or look at the underlying budget and forget that we are talking about a brother, a father, a sister [or] a child,” said Bollier, a Mission Hills Republican. “We’re talking about real people who want and need access to care.”
A bipartisan group of senators fought off a series of amendments offered Monday by expansion opponents.
One from Sen. Dennis Pyle, a conservative Republican from Hiawatha, touched off a contentious debate. It would have denied coverage to otherwise eligible Kansans living in communities that shelter undocumented immigrants, so-called sanctuary cities.
“I’m not out to hurt or harm anyone,” Pyle said, explaining that his amendment was an attempt to pressure city and county officials across the state to comply with the letter of federal immigration law.
Referring to the amendment, which was defeated 25-13, as a “hate bill,” Sen. John Doll, a moderate Republican from Garden City, said: “I believe it does go after people.”
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.
