News that Kansas Gov. Sam Brownback has softened his position on Medicaid expansion wasn’t exactly racing through the Statehouse on Thursday.
But it certainly had some legislators buzzing.
In remarks Wednesday to conservative lawmakers in Missouri, Brownback said if the Kansas Legislature presented him with a budget-neutral expansion bill, he would likely sign it, according to a report in the Missouri Times.
Rep. Don Hill, an Emporia Republican who has been negotiating with the governor and others on the issue, said he was surprised but not shocked by the governor’s remarks.
“It’s good news obviously,” Hill said. “It’s movement.”
Rep. Barbara Bollier, a Mission Hills Republican, said, “If this is true, I’m thrilled for the people of Kansas.”
Expanding Medicaid eligibility, Bollier said, “is about social justice.”
Two weeks ago, Rep. Dan Hawkins, the Wichita Republican who chairs the House Health and Human Services Committee, said he had no plans to schedule hearings on a Medicaid expansion bill introduced by Hill at the request of the Kansas Hospital Association. But just before lawmakers left for a mid-session break, House leaders agreed to allow hearings to prevent an immediate floor vote on the KHA proposal.
Those hearings have been scheduled for March 18 and 19.
Brownback has made it clear that any Medicaid expansion bill that reaches his desk must cover the state’s share of the costs.
The Affordable Care Act obligates the federal government to cover 100 percent of states’ expansion costs through 2016 and not less than 90 percent thereafter.
Eileen Hawley, Brownback’s spokesperson, said the governor wants to “fully understand” the fiscal impact of Medicaid expansion and the potential costs if the federal government “is unable to maintain the 90 percent match” due to its own budget problems.
Like the governor, Rep. Mark Hutton, a Wichita Republican, has concerns about the budget implications of expanding Medicaid eligibility. But he said lawmakers can’t continue to ignore the issue. It’s too important, he said, to the financial stability of hospitals that need expansion to offset reductions in Medicare reimbursements – rural hospitals in particular.
“The rural hospitals are the ones that are really on the guillotine,” Hutton said. “I think not doing something puts rural health care at risk.”
A study commissioned by the hospital association estimated expansion would cost the state an additional $312 million through 2020. But the same study said an infusion of an additional $2.2 billion from the federal government between 2016 and 2020, combined with potential savings in other programs, would more than offset the cost of expansion.
In addition, Kansas hospitals have said they are willing to discuss increasing a state assessment on their revenues to help cover expansion costs.
“There is going to need to be a compelling case made that this can be done while being neutral to the budget,” Hill said. “That may be a difficult sell, but I believe it is a sell that can be made.”
The bill the hospital association is advocating would repeal language added to a budget bill in 2013 that prohibits the Brownback administration from crafting an expansion plan and negotiating its approval with federal officials. Passage of the bill would allow the governor to propose an expansion plan similar to those being pursued by other Republican governors.
These so-called red state plans use federal Medicaid funds to help low-income adults purchase private coverage. Many also require recipients to share in their health care costs in ways that traditional Medicaid doesn’t.
Kansas’ privatized Medicaid program, KanCare, covers about 425,000 children and low-income, disabled and elderly adults. But that number includes relatively few non-disabled adults. Adults with dependent children can participate in KanCare, but only if they have incomes below 33 percent of the federal poverty level, $7,770 annually for a family of four.
Adults without children aren’t eligible for coverage no matter how poor they are. Expansion would make all Kansans with incomes up to 138 percent of the federal poverty level eligible for KanCare. The eligibility cap would be set at annual income of $16,105 for an individual and $32,913 for a family of four.
Estimates vary, but Medicaid expansion would extend coverage to between 140,000 and 170,000 Kansans.
Though Brownback appears to be more open to expansion, Hawley said he remains committed to reducing the number of disabled Kansans waiting for KanCare services “before expanding eligibility to able-bodied Kansans.”
KHI News Service reporter Andy Marso contributed to this story.
Jim McLean is executive editor of KHI News Service in Topeka, a partner in the Heartland Health Monitor team.