Senate budget amendment underscores opposition to Medicaid expansion

But senators express varied views on its import

0 | Legislature, Health Reform, Medicaid-CHIP

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Sen. Dennis Pyle

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— The budget bill that passed the Senate today includes an amendment that would bar state agencies from spending any money to expand eligibility for the Kansas Medicaid program without the expressed consent of the Legislature.

“What this amendment says is that should the governor make the decision to expand Medicaid, the Legislature would have to consent,” said Sen. Dennis Pyle, a Republican from Hiawatha. “If the governor chooses not to (expand Medicaid), then we have no vote. But if he does, then it’s a fall-back.”

Pyle, who carried the amendment, said he hopes Gov. Sam Brownback decides against expanding Medicaid.

'It's Obamacare'

“It’s Obamacare,” Pyle said. “It gets us in the practice of accepting and allowing more federal control of our health care.”

The amendment, introduced during floor debate Wednesday evening, passed on a voice vote. On Thursday, the bill – Senate Substitute for House Bill 2143 – passed the Senate, 24-16.

Brownback has said he’s not yet decided whether expanding Medicaid would be in the state’s best interest, noting that expanding eligibility to include all Kansans who earn up to 138 percent of federal poverty guidelines — $31,809 for a family of four —would cost the state an additional $600 million over 10 years.

A spokesperson for the Governor’s Office said the administration welcomed the amendment.

“The Senate's budget amendment confirms what the administration has always stated: The Legislature must be involved in any decision related to expanding Medicaid,” said Sherriene Jones-Sontag, the governor's chief spokesperson. “We look forward to working with our partners in the Legislature as we craft Kansas solutions to Kansas health care challenges."

Senate Majority Leader Terry Bruce said the amendment underscored the chamber’s opposition to an expansion.

“Based off of what I heard last night,” Bruce said Thursday before the Senate took final action on the measure, “I’d have to say that as a whole the Senate is not very enthused about the prospect of expanding Medicaid.”

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Senate Majority Leader Terry Bruce, R-Hutchinson.

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No path clearing

Bruce said he doubted that the Governor’s Office was leaning toward expansion.

“If they were, they would be acting right now to kind of clear a path to allow (expansion) to occur,” he said. “To do something like that would take more time, more energy, and more preparation that what we’re seeing. I haven’t seen any signs of that occurring.”

Others said they weren’t sure what the make of the amendment.

“The intent, I think, was to make it so that (expansion) wasn’t solely an executive branch decision,” said Sen. Ty Masterson, an Andover Republican and chair of the Senate Ways and Means Committee. “But if the governor makes the decision to expand Medicaid, he would need to get the Legislature’s consent for expenditures anyway. I don’t know that the amendment helps or hurts. I’d couch it as neutral.”

Symbolic

Sen. Laura Kelly, a Topeka Democrat and ranking minority member on the budget committee, called the amendment “more symbolic than substantive. If we’re going to expand Medicaid, it doesn’t stop us; if we’re not going to do it, it doesn’t help us.”

Senate President Susan Wagle, a Wichita Republican, said she was telling fellow senators to “keep our options open. We don’t know how Obamacare will be implemented, what its effect will be on the state and on our health care system.”

Because the amendment was not in the House-passed version of the bill, it will be the subject of conference committee discussion when the two chambers later try to resolve differences on the bill.

Rep. David Crum, an Augusta Republican and chair of the House Health and Human Services Committee, said he would support the amendment.

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Rep. David Crum, R-Augusta

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“I don’t think the House wants to expand Medicaid without there being legislative consent,” he said. “We have the authority to expand Medicaid anytime we choose to. We don’t have to have a decision this year to expand Medicaid. The law doesn’t limit when you have ability to expand Medicaid.”

Crum, also vice chair of the House Social Service Budget Committee, said he thought the state’s Medicaid programs were “doing a really good job.”

Expansion, he said, would put the services in jeopardy.

“You have to wonder at what point the federal government is going to overextend itself,” Crum 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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