Analysis: Another Kan. debate over Medicaid likely

Kansas Flag (KSN Photo)
Kansas Flag (KSN Photo)

TOPEKA, Kan. (AP) — Kansas legislators likely will have  another debate next year over expanding the state’s Medicaid program, despite the antipathy from conservative Republicans toward the federal health care overhaul that prevented such a move this year.

The GOP-dominated Legislature inserted provisions in the state’s current and next annual budgets to block an expansion of Medicaid, which covers health care for the needy and disabled. Republican leaders don’t trust promises from the federal government to provide almost all of the funding for the expansion, and they want Kansas entangled as little as possible with a federal law championed by President Barack Obama, a Democrat.

But they probably face another debate because of what advocates of an expansion see as a perverse result with major parts of the federal health care overhaul kicking in next month. Those advocates expect thousands of poor Kansas adults to remain without health coverage, even as the federal government provides subsidies to better-off neighbors.

Insurance Commissioner Sandy Praeger, one of few Kansas Republicans who hasn’t publicly trashed the overhaul, heard mutterings of disbelief when she walked through a crowd of about 250 people last week in Overland Park.

Praeger and other advocates of a Medicaid expansion expect word-of-mouth among poor Kansans and their neighbors will pressure legislators to reconsider. Republican leaders who oppose the expansion expect advocates to push the idea again. Prominent Democrats also want to raise the issue ahead of next year’s campaign against Brownback’s re-election.

“A lot of people will talk about it,” said Cathy Harding, executive director of the Kansas Association for the Medically Underserved, which favors an expansion.

The budget provisions approved this year by the Republican-controlled Legislature prevent Brownback from acting on his own to expand Medicaid in line with the federal health care overhaul. But the administration already had produced a study suggesting an expansion would cost the state an additional $600 million over the next decade, despite the federal government’s promise to fund all of the cost through 2016 and at least 90 percent after that.

Lt. Gov. Jeff Colyer, a surgeon, criticized the law as burdensome to states during a congressional hearing last week. He said most people in Kansas reject a “Washington-centric” system, citing as part of his evidence the conservative Legislature elected by state voters.

The federal law overhauling health care assumed that states would expand Medicaid — and would have forced them to do so, had the U.S. Supreme Court not ruled such a mandate unconstitutional. The expansion was aimed at reducing the number of people without health coverage, about 358,000 in Kansas, according to the latest U.S. Census Bureau estimates.

The federal law calls for subsidies for health insurance purchased in new online marketplaces when a family’s income ranges from being at the federal poverty level to four times that level. For a single parent with two children, that’s a household income from $19,350 to $78,120. Medicaid coverage is supposed to kick in below the federal poverty level.

But in Kansas, able-bodied adults with children aren’t eligible for Medicaid coverage themselves until their household incomes fall to 32 percent of the poverty level — less than $6,200 for a family of three. And single, able-bodied adults aren’t eligible for Medicaid at all.

Praeger told her audience in Overland Park that between 130,000 and 150,000 adults will “fall through the cracks.”

“I’m still hopeful that we’ll decide to take the Medicaid expansion, because there’s a big gap,” Praeger said to applause. “It’s not going to be fun to tell people they’re too poor to qualify.”

Bruce noted that poor families are eligible for other social services, and at least a few Kansas Republicans see the situation as an incentive for work. For single, able-bodied adults, the federal poverty level — at which they qualify for a health insurance subsidy — is $11,490. Someone earning the minimum wage of $7.25 an hour can exceed that threshold by working an average of 31 hours a week throughout the year.

Republicans such as Colyer and Bruce have questioned whether the federal government could keep paying for almost all of states’ Medicaid expansions, given its own fiscal problems.

Also, Bruce said, “There’s a negative feeling amongst legislators that it’s just an extension of Obamacare.”

Yet Bruce expects a robust debate on the Medicaid expansion. As advocates for an expansion push for lawmakers to reconsider their opposition to it, he said they’re likely to fuel a response from GOP conservatives determined to ensure that there’s no chance for Brownback to enact the policy.

And Senate Minority Leader Anthony Hensley, a Topeka Democrat, said, “Very definitely, we’ll raise the issue.”

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