Kansas Senate, House bills propose Medicaid expansion

Medicaid expansion is officially up for debate in the Legislature, but passage still seems unlikely.

The Kansas Hospital Association authored a plan dubbed “The Bridge to a Healthy Kansas.” The proposal was submitted as Senate Bill 371 and House Bill 2633, which was read Monday on the House floor.

The association said its expansion plan would not only be budget neutral, but a moneymaker for the state’s general fund.

Among many aspects of the bill, the plan includes: U.S. citizenship requirements, Kansas residency for at least a year, employment incentives and personal responsibility through deductibles, premiums and penalties for recipients who don’t pay.

Medicaid is a state and federally funded program that provides insurance for people with low incomes or disabilities. Kansas has a privatized system called KanCare.

Thus far, 31 states have expanded Medicaid, four are discussing expansion and 16 – including Kansas – have not expanded.

More than half of the estimated 150,000 Kansans who could gain insurance coverage from expanded Medicaid are employed, according to analysis from the hospital association.

Much of Kansas’ resistance to expansion stems from its ties to the Affordable Care Act. The act was passed with the expectation of nationwide Medicaid expansion. The Supreme Court later allowed each state to decide whether to expand.

Private-sector support for Kansas expansion has grown since the closure of Mercy Hospital in Independence last October. Other hospitals around the state have attributed revenue declines, in large part, to the cost of donated care for uninsured patients.

Several cities, counties and private-sector associations included Medicaid expansion as a legislative priority for this session – citing potential for economic growth and lower business costs as the reasons.

But despite that momentum over the past few months, political leadership remains uninterested in expanding.

Ray Merrick, speaker of the Kansas House of Representatives, said in an email Monday that evidence against expansion is “overwhelmingly clear” in other states.

“Expanding Medicaid is consistently over budget and puts in jeopardy every other important responsibility of state government, like education, and safety net services for truly low-income and disabled Kansans,” his statement said. “That is not fair nor compassionate.”

Paje Resner, director of policy and communication for Senate President Susan Wagle, said Wagle was not ready to comment on the specifics of the bill at this point.

Gov. Sam Brownback’s office did not return requests for comment.

In the past, Brownback has said he would only consider expansion proposals that are budget neutral with sustainable funding, have a workforce component for recipients and include a way to lower the state’s waiting list for disability services.

Advocates for expansion – including the state’s disability community – have repeatedly said the waiting list is a separate issue not intertwined with Medicaid expansion.

The association’s proposed plan incorporates a series of efforts before the session to persuade Republicans to expand Medicaid.

In November, 14 health care organizations hosted panel discussions with Indiana lawmakers about how Indiana created an unconventional expansion plan in conjunction with its conservative Republican leadership.

In January, the Kansas Hospital Association hosted a follow-up panel discussion in Overland Park before the start of the session. It plans to host another KanCare forum March 2 in Topeka.

In December, six health foundations across the state commissioned a study about how Medicaid expansion could save the state money.

Based off that study, the Kansas Hospital Association projects its plan would cost the state about $32 million in 2017, but would save the state $183 million the same year. Those savings would come from programs the association anticipates would be eliminated or lessened.

For 2020, the association projects expansion would cost roughly $88 million, but save the state $239 million.

Republicans previously discredited the study that was used to calculate those savings.

Merrick called the research group a left-wing law firm. Brownback criticized the credibility of one of the authors because of her work under Kathleen Seblius. Rep. Daniel Hawkins, chairman of the Health and Human Services Committee, said the study’s five-year analysis was too narrow and underestimated costs.

This story was originally published February 8, 2016 at 8:10 PM with the headline "Kansas Senate, House bills propose Medicaid expansion."