Gov. Sam Brownback, who has been critical of Medicaid expansion, must now decide what to do with an expansion bill approved by the Legislature.
The Senate gave final approval to expansion in a 25-14 vote Tuesday. The House approved the legislation earlier.
The governor has 10 days after he receives the bill to sign or veto it. If he does nothing, the bill becomes law.
Brownback spokeswoman Melika Willoughby said Monday that the Affordable Care Act is in a “death spiral” and that expanding Medicaid eligibility would not be responsible policy.
The act, also known as Obamacare, allowed states to expand eligibility for Medicaid to cover people who earn too little to buy insurance through the federal health care exchange but too much to otherwise qualify for Medicaid.
The federal government pays for 90 percent of the expansion costs for states that extend Medicaid coverage to people at up to 133 percent of the federal poverty line. Some 150,000 Kansans could join Medicaid under expansion.
In the past, Brownback has said any expansion must be budget neutral and must require able-bodied recipients to work. He also has said Kansas must provide services for eligible disabled Kansans on waiting lists before able-bodied adults.
A statement from Willoughby hinted that the bill does not meet Brownback’s test.
“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,” Willoughby said.
‘High on happiness’
Still, the mood among people who have sought Medicaid expansion for years was jubilant. Sen. Barbara Bollier, R-Mission Hills, said she was “high on happiness.”
Supporters hope that Brownback will change his mind on expansion or that they can come up with enough votes to overcome a veto.
Brownback could have expanded Medicaid on his own. But he signed a bill in 2014 that required legislative approval of expansion. Supporters now say that bill should weigh heavily on Brownback’s decision.
“If it was me, I’d actually want to do something for the people maybe,” Bollier said of the governor’s choice on the bill. “Instead of going out unpopular and Ivan the Terrible, let’s leave Ivan the Terrible off.”
To override a veto, supporters need 84 votes in the House and 27 votes in the Senate. Bollier said she knows of one “no” vote that could flip to “yes” in the Senate, and added that if there’s one vote, there might be two – enough for an override in the Senate.
The House approved the bill 81-44 and would need three more votes to override.
The Senate vote came after an effort in Congress to repeal the Affordable Care Act failed. The bill that was before Congress would have blocked states from expanding Medicaid.
After he pulled the bill, U.S. House Speaker Paul Ryan said the current law was likely to remain in place for the foreseeable future.
Rep. Susan Concannon, R-Beloit, said events in Washington brought a new perspective to the debate in Kansas.
“I’m hopeful that gives the governor a different perspective as well,” Concannon said.
The Kansas House vote took place before the failure of the federal bill. Lawmakers who had expressed reservations about supporting expansion because of federal uncertainty may now be more inclined to support a veto override, said Rep. John Carmichael, D-Wichita.
“You take that off the table and that may pick up the necessary votes to override the veto,” Carmichael said. “It’s my hope, however, that the governor will do the responsible thing and at the least allow this to become law without his signature.”
Hoping for veto
Both supporters and opponents of expansion expected the measure to pass. Opponents now hope for a veto.
Rep. Dan Hawkins, R-Wichita, who opposes expansion, said he can’t see Brownback letting the expansion happen.
“If he holds to what he’s said in the past, I would say he’ll probably veto it,” Hawkins said.
Senate Majority Leader Jim Denning, R-Overland Park, also predicted a veto – and he predicted a veto would be upheld by the Legislature.
The timing of the bill wasn’t good, he said.
“We need to figure out if anything’s going to change in D.C.,” Denning said.
Contributing: Bryan Lowry and Hunter Woodall of the Kansas City Star