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April 15, 2013
TOPEKA Advocates pushing Kansas officials to expand Medicaid acknowledge it is unlikely they will achieve their goal this year.
But they said they remain hopeful they can convince Gov. Sam Brownback and legislators next year to make more Kansans eligible for the program.
“If it’s not going to happen the first year, we’ll continue to build grassroots support. We’re not giving up,” said Anna Lambertson, director of the Kansas Health Consumer Coalition, one of the groups pushing for expansion.
Medicaid, known in Kansas as KanCare, currently provides medical and long-term living assistance services for about 380,000 poor, disabled and elderly Kansans. Expansion could increase enrollment in the program by as many as 240,000, according to various projections.
The federal Affordable Care Act initially required states to expand Medicaid eligibility. However, the U.S. Supreme Court decision that upheld the law made expansion optional for states.
Expansion would have a bigger impact in Kansas than in many other states. That’s because the state’s current eligibility criteria exclude all but the poorest adults. Only those with children and incomes less than 32 percent of the federal poverty level — about $6,000 a year for a family of four — can qualify. Implementing expansion would mean that adults in that same family of four could make more than $31,000 a year and qualify.
The Brownback administration has estimated that expanding eligibility for the $3.2 billion program would cost the state an additional $600 million over 10 years.
Whenever asked about expansion, Brownback says things that suggest he’s more likely to say “no” than “yes” to it. But advocates said they remain encouraged by the fact he hasn’t rejected the idea.
“If he’s really looking at the options with an open mind — as he himself has said he’s doing — then I see him taking his time (to decide) as beneficial,” Lambertson said. “I’d rather that he take his time than just say ‘no’.”
Last week, Brownback again expressed doubts that the federal government could afford to keep its promise to cover all the costs of expansion for the first three years and no less than 90 percent thereafter. Despite his misgivings, he said, he continues to have “active conversations” with expansion advocates and legislators on the topic.
“It’s in the legislative process,” Brownback said. “Expansion would have to be addressed by the Legislature. They would have to budget it.”
Members of the House-Senate conference committee negotiating a final version of the fiscal 2014-15 budgets are scheduled to return to the bargaining table early next month when the Legislature returns to Topeka for what leaders hope will be a brief wrap-up session.
Medicaid expansion is not expected to be an issue in those negotiations. Conferees have already agreed to a proviso in the fiscal 2014 budget bill that would prohibit the governor from moving forward with expansion without legislative approval.
KHI News file photo
Rep. David Crum, the chairman of the House Health and Human Services Committee, represents what appears to be the prevailing view among Republican legislators. Like Brownback, Crum said he was concerned that budget and deficit problems would make it hard for the federal government to keep its Medicaid funding promises.
“If our budget was balanced and we had a very manageable national debt, I think it would probably make sense to talk about expanding Medicaid. But under the circumstances I don’t understand how we can talk about it,” Crum said.
Rep. Jim Ward, a Wichita Democrat who favors expansion and introduced a stalled bill calling for it, described the provision in the budget bill as “political shenanigans,” because it was approved in the Senate but never debated on the House floor.
“Ultimately, people in this building have to be responsive to the voters. At the end of the day the people are going to demand to know where you stand on Medicaid expansion,” Ward said.
Though his chances of success are slim, Ward said he hopes to force “and up or down” vote on Medicaid expansion during debate on the budget bill.
“The people who would qualify for an expanded Medicaid program deserve a vote,” Ward said. “We’re going to push this thing until the sine die gavel goes down.”
A statewide poll done late last year for the Kansas Hospital Association showed 60 percent support for expanding Medicaid. Only 24 percent of those surveyed opposed expansion, while 16 percent said they weren’t sure.
A study commissioned by the hospital association concluded that expanding Medicaid would increase federal spending in Kansas by $3 billion by 2020 and create 4,000 new jobs.
That report combined with decisions by several other “red state” governors to go along with expansion is helping to generate some momentum for expansion in Kansas, said Rep. Don Hill, an Emporia Republican who supports broadening the Medicaid program.
“You see a division between the more ideological folks and the more pragmatic folks (in the Statehouse) and at the end of the day I think the pragmatic side is gaining,” Hill said. “We need to do the best we can to leverage what opportunities are there and expanding Medicaid, I think, would make very good sense.”
The GOP-controlled Legislature in Arkansas was hostile to expanding Medicaid until Democratic Gov. Mike Beebe came up with a more attractive option: using federal Medicaid dollars to purchase private coverage for those made eligible by the expansion.
Several GOP governors, including Brownback, have taken notice of the agreement that Arkansas officials say they have struck with federal Medicaid authorities. And expansion advocates who initially resisted the idea now seem more open to it.
“It’s something we would look at very seriously. We just want to cover more people, that’s what we care about,” Lambertson said.
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