The Following is Part One in a two-part series on Medicaid Expansion
Last year, Democrat Laura Kelly was elected Governor of Kansas promising, among other things, to expand the state’s Medicaid program under the provisions of the Affordable Care Act. However, while Medicaid Expansion passed the State House of Representative in March, the legislation has been stymied in the State Senate, and Kansas remains one of the 14 states that have not expanded Medicaid. The battle over Medicaid Expansion is going to continue in the legislature’s next session.
Kansas is regarded by some advocates as doing the bare minimum. Medicaid is not offered to childless adults and is only available to parents making up to 38 percent of the federal poverty line, and those with disabilities making up to 74 percent of the federal poverty line, with more benefits available for children. Those who make between 100 and 400 percent of the federal poverty line are eligible for subsidized private health insurance plans from the Federal government. The amount varies depending on income, with more subsidies available to those closer to the poverty line. Currently, the Federal government pays up to 60 percent of the cost, with the rest coming out of the state budget. This leaves many Kansans in a situation where they make too much money to qualify for Medicaid under the state’s rules but too little to qualify for subsidies from the Federal government, what is commonly referred to as the Medicaid Gap.
Medicaid Expansion would extend coverage to those in the Medicaid Gap, to people making up to 138 percent of the federal poverty line – roughly $16,753 per year for a single adult – with 90 percent of the costs being covered by the Federal Government. In Kansas, it is estimated that approximately 150,000 people would be eligible for coverage under Medicaid Expansion.
Medicaid Expansion legislation was passed by a coalition of Democrats and moderate Republicans in the Spring but was blocked by the Senate. State Representative Susan Ruiz (D-Lenexa) lays the blame for this squarely on Senate Majority Leader Jim Denning (R-Olathe) and Senate President Susan Wagle (R-Wichita), who refused to add the legislation to the agenda in the last session.
“It’s in the hands of two people and it’s disgusting to me that they don’t have the moral compass to see how what they are doing not allowing Medicaid [Expansion] to happen,” Ruiz said.
Some Senators attempted to overrule the Senate leadership and add the Medicaid Expansion to the agenda in the final week of the last session but fell just one vote short.
Denning has stated he intends to bring his own version of Medicaid Expansion to the Floor when the next session begins in January. He has formed a committee to draft the legislation which began meeting this last week.
This Senate version has not been finalized yet but includes a provision to increase taxes on cigarettes by a dollar a pack, and a 5 cent per milliliter tax on vaping products, which would bring in an estimated $50 million in revenue. It would also add a $31 million dollar surcharge on hospitals and $63 million in fees assessed for managed care organizations serving Medicaid clients. Denning has argued that these taxes and fees are necessary to ensure Medicaid Expansion is revenue neutral.
Senate President Susan Wagle previously floated the idea of adding work requirements for able-bodied recipients. However, such provisions were not included in Denning’s plan, much to the dismay of many conservative state legislators. The federal government has so far rejected all Expansion plans that included work requirements.
When reached for comment, State Representative Rui Xu (D-Westwood) says that he expects Denning’s version of Medicaid Expansion to pass the Senate in the next session, meaning the legislation will come down to the conference committee, which leans conservative. He suspects this will result in the final version looking more like Denning’s yet-to-be-released plan. This could kick off a new fight in the state legislature next year if the House doesn’t approve the plan to come out of the conference committee.
“It all comes down to who plays the game,” according to Xu.
He noted that it depends how willing moderate Republicans in the House will be to pass a version that doesn’t include as expansive coverage. Ruiz said she thinks “The majority of us,” referring to legislators who support Medicaid Expansion, “are ready for a fight and ready to mobilize if we need to.” She went on to say that the efforts of community organizations, activists and constituents are going to be crucial in making sure the best possible version of Medicaid Expansion is enacted. Xu and Ruiz both said that Medicaid Expansion is going to be a top priority in the next session, not only for them but for everyone involved.
This view was also expressed by Governor Kelly in a recent statement.
“I have been clear that Medicaid Expansion will be my No. 1 priority in 2020,” Kelly said.
The Governor further expressed her support for the version passed by the House in the last session.
“Simply expanding the Medicaid-eligible population to include adults who make up to $16,753 per year is the best path forward,” Kelly said.
She encouraged state legislators to look at the experiences of other states that have expanded Medicaid.
“States with the best results and the most financial gain have the simplest plans,” Kelly said.
It is certain that the battle over Medicaid Expansion will be the defining issue of the next session for the Kansas legislature, but the outcome remains uncertain.