Medicaid expansion advocates setting sights on next year

Governor and Legislature unlikely to address the issue further during the upcoming wrap-up session

0 | Health Reform, Medicaid-CHIP

Gov. Sam Brownback talking with Anna Lambertson of the Kansas Medicaid Access Coalition last month at the Statehouse. The coalition delivered a petition with more than 2,700 signatures urging expansion of the state Medicaid program, which currently has among the tightest restrictions in the nation.

Gov. Sam Brownback talking with Anna Lambertson of the Kansas Medicaid Access Coalition last month at the Statehouse. The coalition delivered a petition with more than 2,700 signatures urging expansion of the state Medicaid program, which currently has among the tightest restrictions in the nation.

— 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.

Door still open

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.”

Brownback’s requirement that legislators budget for it before he would sign off on it has advocates convinced a decision won’t be made this year.

Budget negotiations

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.

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KHI News file photo

Rep. David Crum, R-Augusta

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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.”

Advocates say “momentum” growing

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.

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Rep. Don Hill, R-Emporia.

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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.”

Arkansas option

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.

KHI News Service coverage of Medicaid expansion

Medicaid Access Coalition launches online "ticker" showing foregone federal dollars (2/13/14)
→ KHI report: Nearly 182,000 Kansans in the ‘Eligibility Gap’ (1/11/14)
House speaker says Medicaid expansion is "up to the governor" (1/10/14)
KS Senate president says Medicaid expansion unlikely to gain approval this session (1/7/14)
Profiles of the coverage gap: Kathleen Christian (1/6/14)
Efforts continue to expand Medicaid in Kansas and Missouri (1/6/14)
Hospital association hires former Bush HHS secretary to help craft a plan Kansas Republicans might support (12/23/13)
Iowa wins approval to expand Medicaid by using federal funds to buy private insurance (12/11/13)
White House officials hold call to urge Medicaid expansion in Kansas (11/21/13)
Republican governor talks up plan to expand Medicaid — his way (10/28/13)
Challenger says Brownback owes voters a decision on Medicaid expansion (10/22/13)
Nearly 5.2M Americans fall in coverage gap in states not expanding Medicaid (10/16/13)
Sebelius: Feds flexible on how states expand Medicaid (9/22/13)
Sebelius says Kansas and Missouri are missing the boat on Medicaid expansion (9/20/13)
Medicaid expansion coalition finds strength in numbers (9/17/13)
Republican Gov. Corbett proposes expanding Pennsylvania Medicaid (9/16/13)
Kansas lawmakers urged to consider Medicaid expansion by Wesley CEO (8/29/13)
Estimating maneuver could help more people gain from Obamacare: How the poor might qualify for Affordable Care Act subsidies in states that don't expand Medicaid (8/12/13)
Report: States not expanding Medicaid stand to benefit most from doing so (7/18/13)
CMS won’t penalize hospitals in states slow to expand Medicaid (5/14/13)
Insurer Centene: We can do Arkansas-style Medicaid (5/14/13)
The Arkansas Medicaid Model: What you need to know about the 'private option' (5/2/13)
Nothing to be done about coverage gap in states not expanding Medicaid, feds say (4/29/13)
Brownback says he's listening to Medicaid expansion proponents, opponents (4/5/13)
Oregon shows costs of putting Medicaid enrollees in private coverage (3/29/13)
Governor urged to expand Medicaid eligibility (3/27/13)
Arkansas Medicaid expansion attracts other states' interest (3/26/13)
Senate president prefers options remain open on Medicaid expansion (3/25/13)
States urged to expand Medicaid with private insurance (3/22/13)
Senate budget amendment underscores opposition to Medicaid expansion (3/21/13)
Study: Kansas employers face millions a year in possible penalties without Medicaid expansion (3/15/13)
More than 30 Kansas groups pushing for Medicaid expansion (3/12/13)
Health insurers see big opportunities in health law’s Medicaid expansion (3/8/13)
Medicaid expansion supporters to step up lobbying efforts (3/7/13)
Budget committee hears resolution opposing Medicaid expansion (2/22/13)
Legislators focusing on Medicaid expansion cost estimates (2/19/13)
Kansas hospital group study predicts expanding Medicaid would generate 4,000 jobs (2/18/13)
Brownback officials release their cost projections for Medicaid expansion (2/8/13)
Medicaid expansion bill introduced (1/22/13)
Kansas hospitals worried about loss of dollars for charity care (1/14/13)
Brownback compiling own estimate of Medicaid expansion cost (12/20/12)
Group urges Brownback to expand Medicaid eligibility (11/9/12)
Debate begins on possible Kansas Medicaid expansion (10/25/12)
Amerigroup CEO says states ‘need’ to go along with Medicaid expansion (7/11/12)
Kansas hospitals ready to get on with federal health reform, spokesman says (7/2/12)
Kansas AG claims partial victory in health reform case (6/29/12)
High court upholds Affordable Care Act, but ruling puts limits on Medicaid expansion (6/28/12)

Commentary
→ Kansas Hospital Association: An opportunity for the Kansas Medicaid program
→ Americans for Prosperity-Kansas: Well-intentioned policies do more harm than good
→ Health Reform Resource Project: The cost of not expanding Medicaid
→ Rep. Jim Ward: Medicaid expansion essential for healthier Kansas
→ Rep. David Crum: Reasons for opposing Medicaid expansion
→ National Academy for State Health Policy: Much ado about Arkansas: Medicaid in the insurance exchange

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