The Kansas legislature is back in session this week but they probably won’t be debating a Medicaid expansion, after a recommendation from Gov. Sam Brownback.
Expansion supporters had hoped that at least an expansion compromise could happen this year. But the governor’s statement makes any expansion in the near future all but impossible, because the GOP controlled House has said they will only take up the issue at the governor's urging.
Still, many in the state are pushing for some change to Medicaid, which was intended to be part of the Affordable Care Act.
Under the ACA, people and families living between 100 and 400 percent of the federal poverty level can get insurance subsidies. People below that level go on state Medicaid. That adds a lot of new people to Medicaid, so the federal government is offering to pay all of the added cost for states for three years, tapering down after that, but never to less than 90 percent of the additional costs.
Supporters say it’s a great deal, but opponents like Republican Rep. David Crum of Augusta support the Governor’s decision to shut the door.
“We have to consider what it will do to our budget in the long term. As legislators, we can’t make decisions based on what’s going to happen in the next three years,” says Crum.
Medicaid currently covers about 343,000 Kansans, and Crum estimates expansion would bring that number up to 450,000. That’s about 20 percent of the state population. Crum says expansion would add more weight to an already massive state program.
“We’re already supporting a very important group of Kansans who need significant help,” he says.
Kansas had been considered a “maybe” on Medicaid expansion, but that changed with the Governor’s statement Monday.
Republican Rep. Barbara Bollier from Mission Hills criticizes the Governor’s decision. Unlike many in her party, she supports expansion and doesn’t believe it inevitably means big future costs.
“We have to look at a long-term costs of everything, I agree," she says. "However, just expanding at this point doesn’t mean we are locked into it.”
Bollier points out that the state already receives lot of money from the federal government. And that by refusing federal money, Kansas is simply allowing it to go to other states.
“That money belongs to the people of Kansas as much as it belongs to any other people of any state, and I hate to see us losing our money that we put into the federal government through our taxes,” says Bollier.
One of the biggest stakeholders in an expansion is the Kansas Hospital Association. That’s because the Affordable Care Act is funded in part by huge cuts to the money the federal government gives hospitals for treating people who can’t pay.
The idea is that if Medicaid expands to include the uninsured, then this funding won’t be needed because everyone will be covered. As it stands, Kansas hospitals face losing that federal funding while still having to serve many uninsured.
Tom Bell is President and CEO of the Kansas Hospital Association. He says they’ll continue their expansion push, despite the Governor’s recommendation.
“I think our strategy has been all along has been let’s try to get the people that are involved – the policy makers and other stakeholders to sit down and have a conversation about whether we can come up with a plan that works uniquely for our state. And going to continue to try to do that,” says Bell.
Bell says the Hospital Association would be satisfied with an expansion that breaks from the Affordable Care Act model, and Gov. Brownback has said he will remain open-minded.
Rep. Crum says legislators have considered alternate expansion models, like Iowa’s premium assistance plan. But any change to Kansas Medicaid would need to be fundamentally different from what the Affordable Care Act prescribes.
“I think it would be difficult to come up with a tweak that would make a significant difference in the way Medicaid expansion would occur,” says Crum.
Some still hold out for the possibility of expansion this year. Rep. Jim Ward, a Wichita Democrat, has said he will attempt to introduce expansion as an amendment or proviso.