Medicaid expansion could gain traction, still politically risky

One of the nation’s politically-risky issues for Republicans could gain some traction in Kansas during the next legislative session.

Health care organizations around the state are hopeful that recent gains by moderate Republicans in the primaries could signal some support, or at least discussion, for Medicaid expansion. Medicaid, called KanCare in Kansas, is the government insurance program for people with low incomes or who are disabled.

On Friday, Gov. Sam Brownback said at a news conference that he still believes all waiting lists should be eliminated before expanding.

“I think this is pretty reasonable,” Brownback said.

More than 3,000 Kansans with intellectual or developmental disabilities are waiting for state disability services through KanCare and the state says a seven-year wait is typical.

Some don’t agree with that logic.

“The governor continues to create a self-imposed waiting list for 150,000 Kansans in the coverage gap and going without health care as a result of the decision not to expand KanCare,” said David Jordan, executive director of Alliance for a Healthy Kansas, in reference to the number of uninsured Kansans who would receive insurance through expansion.

Strategy moving forward

The Kansas Hospital Association led the charge for Medicaid expansion during the last legislative session. The Alliance for a Healthy Kansas has led much of the groundwork for expansion this summer.

Formed in the spring, the alliance is an effort to create support for expansion among Kansans in hopes that wider constituent support would influence legislative action.

The group hosted a series of community meetings and now lists more than 100 organizations as being in support of expansion on its website.

“There was a pretty clear statement in the primaries that the public wants a change of course,” Jordan said. “Overwhelmingly, the candidates that prevailed in last week’s election were candidates that support expanding KanCare.”

The alliance touts the financial benefits of expanding Medicaid.

The Kansas Hospital Association commissioned research about the viability of expansion in Kansas. The research said that expansion would make money for the state, though Brownback and other Republican leadership discredited the research.

The House and Senate did not hold any hearings or discussions about the proposed expansion bill last session.

“It’s irresponsible not to talk about how we can bring hundreds of millions of dollars to the state how we can create jobs for Kansans,” Jordan said.

Politically risky

Brownback’s stance Friday took a different approach to the issue than in January during his State of the State address when he said that Obamacare is failing and is causing financial problems for rural hospitals. “We should not expand Obamacare to solve the problem,” he said at the time.

On Friday, he said: “I’m not opposed. What I’ve said is we’ve got to meet these conditions,” which includes eliminating the waiting lists, placing work requirements on recipients and making certain the expansion does not cost the state money.

The Kansas Hospital Association says the expansion plan it proposed last session met those requirements except for the waiting list elimination, which the association says is an unrelated issue.

Patrick Miller, a political scientist at the University of Kansas, questioned whether the governor and his allies have become more open to expansion because of the primary election.

Moderates prevailed in 10 of 16 contested Republican Senate primary elections.

Even so, he said, supporting expansion remains politically risky.

“They need to get re-elected in two or four years, and they could be attacked for supporting Obamacare,” Miller said.

The risk might be lower for Brownback if he softens his stance, he said.

“It’s probably more of a risk for legislators because his term expires; his approval is 20 percent,” Miller said.

He said he would expect any softening toward expansion to come purely from a financial standpoint.

“It could just be pragmatic for him,” he said. “I suspect it might be just more of a financial reality. There’s money on the table here, why not start a discussion to get that money?”

What legislators are saying

Several legislators expressed support for discussing expansion.

▪ Moderate Sen. Carolyn McGinn, R-Sedgwick, won against her conservative challenger Renee Erickson: “We absolutely should be taking care of the waiting lists, but the waiting list has absolutely nothing to do with the expansion of Medicaid. The waiting list has to do with a poor budgeting process the state has been involved in in the last few years.”

▪ Ed Berger, the former president of Hutchinson Community College, beat Senate Majority Leader Terry Bruce, R-Hutchinson, by 14 percentage points after running on a platform of fiscal responsibility.

“Looking at Medicaid expansion, I would think the process could start before the waiting lists are eliminated,” Berger said. “I just know how important it is to Kansans and to our small rural hospitals. It means a lot to our local hospitals.”

▪ Roger Elliott, a moderate Republican who won the primary in Wichita’s 87th House District, which includes parts of northeast Wichita, said that he’s encouraged that the governor now appears willing to open the door to Medicaid expansion.

“At least there’s a crack,” Elliott said. “That door’s been sealed and dead bolted ten times prior.”

▪ Rep. Jim Ward, D-Wichita, the ranking Democrat on the House Health and Human Services Committee, said the governor was creating false tests in order to never have to address the question.

“Fundamentally, he shows a lack of understanding because more resources into the Medicaid program would provide more resources to reduce the waiting list,” he added.

▪ Rep. Dan Hawkins, R-Wichita, who also is chairman of the KanCare Oversight Committee, said he thinks lawmakers will likely have a chance to vote on Medicaid expansion next session.

“I would say if it gets to a vote, it will probably pass,” he said.

But if it doesn’t meet Brownback’s stipulations, he said: “He’ll veto it. I think he’s pretty solid on his position.”

Contributing: Bryan Lowry of The Eagle

This story was originally published August 13, 2016 at 12:27 PM with the headline "Medicaid expansion could gain traction, still politically risky."