Could Medicaid expansion save Kansas’ rural hospitals?
The Kansas Senate fell one vote short of forcing a Medicaid expansion bill on to its calendar Wednesday, leaving the hot-button issue possibly dead for another year unless supporters can find a new way to advance it.
The vote represents a significant defeat for Democratic Gov. Laura Kelly, who made expansion one of her top priorities.
Democrats tried to use a procedural motion to override Senate leaders and keep expansion alive in the waning days of the legislative session. But the 40-member chamber needed 24 votes and the motion failed 23-13 after Senate majority leader Jim Denning, a Republican from Overland Park, voted “pass” rather than “aye” or “nay.”
“I’m not saying no,” Denning said. “I’m saying this policy isn’t ready.”
Denning said it would not be prudent to spend money on expansion before the Kansas Supreme Court rules on whether the state has satisfied a school funding lawsuit.
The motion nearly passed even without Denning. But after Denning explained his vote on the floor, Sen. Larry Alley, a Republican from Winfield in south central Kansas, changed his “aye” vote and asked that his name be added to Denning’s explanation.
Expansion advocates said Denning and other leaders were simply stalling and obstructing on an issue that has been studied and discussed for about five years.
Sen. Barbara Bollier, a Democrat from Mission Hills, was one of several who decried efforts to bottle up the bill and prevent a straight majority vote.
“To be denied that opportunity through maneuver after maneuver is abhorrent to me and should be to the entire state,” Bollier said.
Some expansion supporters believe they may still be able to pass expansion by holding up the state budget until lawmakers approve it. The Legislature is constitutionally required to pass a budget.
“We can’t leave without passing a budget, so that’s our best leverage, I think,” House Minority Leader Tom Sawyer, a Wichita Democrat, said.
Advocates who rallied outside of the Statehouse before the vote Wednesday and then packed the Senate galleries went home disappointed.
“It’s painfully obvious that Republicans in particular are more concerned with their buddies who already have $500,000 to save up for medical expenses,” said Topeka resident Mary Akerstrom.
Kelly spent political capital to push expansion into law.
She declined to veto a controversial plan to allow the Kansas Farm Bureau to sell unregulated health plans — disappointing patient advocacy groups — in part because the farm bureau agreed to back her expansion push.
After the vote Wednesday, Kelly said Denning and Senate president Susan Wagle were the only ones standing in the way of the will of the majority.
“It is very clear that a strong majority in the Kansas Senate support Medicaid expansion and want the opportunity to debate and vote on it this year,” Kelly said. “I’m pleased with their courage and determination. I’m also grateful for the work of so many advocates and citizens who fought tirelessly during April to make their voices heard on this issue.”
Tensions between Kelly and Denning over Medicaid heightened last week when a negotiating session between the governor and Senate Republicans fell apart.
In an interview with The Star Monday, Denning accused Kelly of threatening his political future and expressing “viciousness towards me personally.” Kelly’s chief of staff, Will Lawrence, disputed Denning’s assertion.
Just hours after the meeting last week, Rep. Cindy Holscher, an Olathe Democrat, announced that she would challenge Denning in 2020, citing his position on Mediciaid expansion.
Polls consistently showed that solid majorities of Kansans supported expansion and it seemed almost certain that Democrats and moderate Republicans had enough votes to pass it if it came to the floor.
But conservative Republican leaders used their procedural powers to keep that from happening.
The Kansas House of Representatives had mustered enough votes to override their leadership, bring it up and pass it in March. But the Senate fell just short.
Wagle, a Republican from Wichita, said the Legislature would study the issue over the summer.
Kansas and Missouri are two of 14 states that have so far declined to expand Medicaid under the Affordable Care Act, commonly called Obamacare.
Right now Medicaid in those states is restricted mainly to low-income children, frail elderly people, pregnant women and people with disabilities.
Expansion under the ACA would extend eligibility to anyone who makes up to 138% of the federal poverty line, or about $35,000 a year for a family of four.
The Kansas Health Institute, a policy think tank, estimates that would mean about 130,000 more people would qualify for Kansas Medicaid, or KanCare, including about 75,000 who are currently uninsured. The program currently has about 400,000 members.
In other states that has provided a windfall for hospitals that under federal law have to provide emergency care for everyone, even if they’re uninsured.
The Kansas Hospital Association has been one of the leaders in lobbying for expansion and Lt. Gov. Lynn Rogers noted Tuesday that four rural hospitals have closed in Kansas in the past three years.
“While we cannot guarantee that Medicaid expansion will save every rural hospital, we are certain that it has the most positive and immediate benefit of anything the state can do,” Rogers said.
Under the ACA, the federal government pays 90% of the cost of expansion. The Kansas Health Institute estimates that the state’s net costs to expand would average out to about $50 million a year over the next 10 years.
Opponents of expansion have argued that it will likely cost much more and that the federal government could renege on its share. They’ve also said that expanding the program to “able-bodied” adults will crowd out funding for more vulnerable populations.
“Medicaid was designed to ensure that Kansas’ most vulnerable have access to the care they need – not able-bodied, working age adults,” said Jeff Glendening, the director of the Kansas branch of Americans for Prosperity, a small government advocacy group. “Expanding Medicaid, as prescribed in Obamacare, will crowd out the most vulnerable in our state who are already using Medicaid while pushing tens of thousands off of their private insurance onto taxpayer-funded government-run healthcare.”
Disability advocacy groups have pushed back against that, saying they want expansion in part because many of the home health workers they rely on are low-income and struggle to maintain coverage.
“My health and safety depend on the health of the people who come into my home and help me out every day,” said Tessa Goupil, a Topeka woman with muscular dystrophy. “Expanding KanCare will make sure my workers get access to necessary medical treatment if they need it, so they can be here when I need them.”
Shorman reported from Topeka.