Kansas lawmakers know they are late to the Medicaid expansion party, but they appear determined to show up anyway.
"I feel like now is as good a time as any," says Anthony Hensley, the leader of the Democratic minority in the state Senate.
For the past three years, Republican Gov. Sam Brownback and legislative leaders were able to block debate on expanding health care for the disabled and working poor via Medicaid, a component of the 2010 Affordable Care Act.
In last year's primary and general elections, Kansas voters — frustrated by chronic budget problems caused in large part by income tax cuts that Brownback pushed through the Legislature — replaced several conservative incumbents with moderate Republicans and Democrats who promised to stabilize the state's finances, fund public education and push for Medicaid expansion.
Coalitions energized by the influx of new lawmakers wasted little time in making good on those promises. The Kansas House recently passed an expansion bill by a margin close to what would be needed to override a Brownback veto, should it come to that.
A Kansas Senate committee is holding hearings on the expansion bill and may vote on Thursday to send it to the floor. That is the same day the U.S. House of Representatives has scheduled a vote on a Republican proposal to replace the ACA.
The replacement bill before Congress would phase out federal funding, starting in January 2020, for expansion programs in 31 states and the District of Columbia as well as any others to implement programs between now and then. But it would not immediately close the expansion window for states that have not acted, says Tom Bell, president of the Kansas Hospital Association.
"From our perspective, this provides some encouragement for states to expand their programs prior to that Jan. 1 of 2020 date," Bell says, noting that the bill would continue funding 90 percent of expansion costs for people enrolled by the deadline.
David Jordan, executive director of a Kansas coalition pushing for expansion, is making a similar pitch to lawmakers.
"This is really an invitation to states like Kansas to expand their Medicaid programs," Jordan says. "We have everything to gain by taking this step and nothing to lose."
To date, Jordan says, the failure to expand Medicaid has cost health care providers and the Kansas economy an estimated $1.7 billion.
Currently, Kansas limits Medicaid eligibility to children and pregnant women in low-income families, people with developmental and physical disabilities, and seniors who cannot afford nursing home care. Parents are eligible only if they earn less than a third of the federal poverty level, or about $9,200 annually for a four-person family.
Single adults without children are not eligible.
Expansion would qualify all Kansans earning up to 138 percent of the poverty level, annually about $16,642 for individuals and $33,465 for a family of four.
An estimated 300,000 Kansans would qualify for coverage under expansion, though only about half that number are expected to initially enroll.
Senate President Susan Wagle, a Republican, says she expects the Kansas Senate to pass the expansion bill next week, perhaps by a vetoproof margin.
But even if Kansas lawmakers are able to advance an expansion plan to the U.S. Department of Health and Human Services, she is not convinced federal officials would give it serious consideration.
"The timing is wrong," Wagle says. "It could just sit there because what I see the feds doing is winding that program down."
KELLY MCEVERS, HOST:
As Congress prepares to replace the Affordable Care Act, lawmakers in reliably red Kansas are racing to expand the state's Medicaid program. Jim McLean of member station KCUR reports.
JIM MCLEAN, BYLINE: Supporters of expanding Medicaid eligibility to approximately 300,000 low-income Kansans, many of whom are uninsured, have already pushed a bill through the Kansas House.
NICK WOOD: Hi, this call is for Diane. Diane, this is Nick...
MCLEAN: Now they're working to secure votes in the Senate.
WOOD: And then we're just reaching out to ask if you might have a quick minute to call your senator, Senator Susan Wagle, and ask her to support KanCare expansion.
MCLEAN: Prior to this session, Republican Governor Sam Brownback and legislative leaders blocked all debate on expansion. But voters frustrated by the state's chronic budget problems ousted several conservative incumbents and replaced them with moderate Republicans and Democrats who promised to fix the state's finances, fund public schools and push for Medicaid expansion.
JOHN EPLEE: It's all about the complexion of your legislature. It's a whole new ballgame.
MCLEAN: That's one of the newcomers, Republican Representative John Eplee. He's a doctor and an expansion supporter. Like other lawmakers, he worries that Kansas may be too late, given language just added to the ACA replacement bill to close the expansion window.
But David Jordan, the head of a pro-expansion coalition, says Kansas lawmakers shouldn't assume that part of the bill won't survive as congressional leaders continue to tweak it in search of votes.
DAVID JORDAN: We have everything to gain by taking this step and nothing to lose.
MCLEAN: Expansion is an emotional issue for many, including Jeremy Presley, a doctor who treats uninsured patients in Dodge City. He testified to a Kansas Senate committee this week.
(SOUNDBITE OF ARCHIVED RECORDING)
JEREMY PRESLEY: I encourage you to take this opportunity before you, do not turn away and not shy away from those people to provide them that care that they need.
MCLEAN: Other witnesses said expansion would more than pay for itself by pulling down additional federal dollars that would cover 90 percent of the cost. It would also mean the state could spend less on other programs. But missed enrollment projections in several expansion states make that a tough sell for some lawmakers. Republican Doug Blex is a first-term House member from the southeast corner of the state.
DOUG BLEX: In most states, seems like there's been more applicants than what they anticipated. So the heart's kind of there. But, you know, it's a pocketbook issue.
MCLEAN: Despite concerns about cost and timing, the House passed the expansion bill with nearly a veto-proof majority. The Senate could vote as early as next week.
For NPR News, I'm Jim McLean in Topeka.
MCEVERS: That story came to us from the Kansas News Service, a reporting collaboration that focuses on health, education and politics. Transcript provided by NPR, Copyright NPR.