Kansas lawmakers now have a plan to expand Medicaid, setting up a showdown between Democratic Gov. Laura Kelly, who has made boosting enrollment in the program a core goal, and Republican leaders, who are vehemently opposed.
Kelly delivered her plan, which she says will provide coverage to some 150,000 Kansans, to lawmakers on Tuesday – Kansas Day – as she had promised. The plan is based on a 2017 expansion bill that was approved by lawmakers but vetoed by then-Gov. Sam Brownback.
“It’s long past time to expand Medicaid so that more Kansans have access to affordable healthcare, our rural hospitals can stay open, and the tax dollars we send to Washington can come back home to Kansas to help our families,” said Kelly. “This bill meets the unique needs of Kansas patients, hospitals, providers, and diverse communities while remaining financially sustainable.”
Kelly’s plan expands eligibility for medical assistance to all adults who are under 65 and don’t make more than 133 percent of the federal poverty level, or $16,611.70 for an individual. Seniors are already covered by Medicare and pregnant women by Medicaid. Expansion would begin Jan. 1, 2020.
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Kelly’s plan also allows the state to create a health insurance premium assistance program for individuals who make less than 133 percent of the federal poverty level and are eligible for insurance through an employer but can’t afford to pay.
In her budget, Kelly asked for $14 million for expansion. Estimates have shown that the costs of expansion will likely rise in future years.
Kansas is one of 14 states that have not expanded Medicaid. The federal government pays 90 percent of the costs for states that expand.
The proposal includes provisions that would end expansion over a year if the federal government curtails financial assistance.
Kelly’s legislation requires the Kansas Department of Health and Environment to refer non-disabled adults who enroll in expanded Medicaid to the state’s existing workforce training programs and work search resources if they are unemployed or working less than 20 hours a week.
But it does not appear to require people to work. The federal government under President Donald Trump has been more willing to consider work requirements for Medicaid.
Many Republicans remain opposed to expansion. House Majority Leader Dan Hawkins, R-Wichita, contends that Kelly has sold “false hope to rural Kansans.” Hawkins and other opponents say the benefits to rural hospitals from expansion are overstated and that expansion provides coverage to able-bodied adults of prime working age.
Hospitals in Independence and Fort Scott in southeast Kansas have closed in recent years. Proponents of expansion often say it will help rural hospitals financially.
Kelly developed her plan with input from a working group she formed composed of lawmakers, state officials and health professionals. On Tuesday, Hawkins called on Kelly to release records related to the working group.
“If an unelected working group is crafting this policy, Kansans deserve to know the details. If the working group truly did nothing, the people of Kansas deserve to know the truth as well,” Hawkins said.
Kelly’s plan would establish a permanent working group that would meet several times a year. The group would be tasked with finding funding outside of the state general fund that could pay for expansion in the event of a funding shortfall.
Rep. Kathy Wolfe Moore, D-Kansas City, formally introduced the bill on behalf of Kelly. She said the legislation closely resembles the 2017 bill that lawmakers previously passed and that lawmakers already know what it’s in it.
“They’re very familiar with this legislation,” Wolfe Moore said.
To pass Medicaid expansion, supporters will need 63 votes in the House and 21 in the Senate. In 2017, the bill passed with 81 votes in the House and 25 in the Senate.
Still, that doesn’t mean supporters have an easy path to passage. The House and Senate have grown more conservative since then, and Republican leaders can slow down the process by not holding hearings on the bill or refusing to allow a debate on the floor of either chamber.