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On January 1, 2017, the KHI News Service became part of KCUR public radio’s new initiative, the Kansas News Service. The Kansas News Service will continue to cover health policy news and broaden its scope to include education and politics. All stories produced by the former KHI News Service are archived here. Stories and photos may be republished at no cost with proper attribution and a link back to KHI.org.

Analysis: Why the Senate has a new health committee leader

Move has implications for Medicaid expansion in an election year

By Andy Marso | February 16, 2016

Analysis: Why the Senate has a new health committee leader
Photo by KHI News Service Sen. Mary Pilcher-Cook had served since 2013 as chairwoman of the Senate Public Health and Welfare Committee. Senate President Susan Wagle ousted her from the committee last week.

Sen. Mary Pilcher-Cook offered an amendment to expand Medicaid last week because she believed it would fail.

A few days later, Senate President Susan Wagle removed Pilcher-Cook as chairwoman of the Senate Public Health and Welfare Committee because Pilcher-Cook pushed the amendment even though it was ruled out of order.

Wagle said she opposes Medicaid expansion but wants the Senate to vote on it in the next few weeks. And now some fellow Republican senators are petitioning to have Pilcher-Cook reinstated.

Confused yet? Welcome to the politics of “Obamacare.”

Pilcher-Cook’s amendment

Pilcher-Cook, a Republican from Shawnee, does not like the Affordable Care Act — commonly referred to as Obamacare — including the Medicaid expansion portion of it.

So why would she offer an amendment to expand Medicaid?

The answer starts in the opposite chamber, where House Speaker Ray Merrick, another expansion opponent, began the session by removing three members of his health committee because they support expansion.

Some legislative watchers think the House might have enough votes to pass a Medicaid expansion bill if it comes to the floor.

Merrick has worked to keep that from happening. But just in case it does, Pilcher-Cook wanted the Senate to “send a message” to the House by soundly voting down her amendment.

The language of her amendment was taken straight from Senate Bill 371 and its companion, House Bill 2633, which proponents call the “Bridge to a Healthy Kansas” program.

The bill was introduced at the behest of the Kansas Hospital Association, which says its members are missing out on hundreds of millions of dollars in federal funds because Kansas has declined to expand Medicaid eligibility. It’s estimated that Medicaid expansion would extend health insurance to 150,000 Kansans.

The Senate rules

The Senate never got to a vote on the Pilcher-Cook amendment.

In another weird twist, a Democrat who supports expansion, Sen. David Haley of Kansas City, challenged whether the amendment was germane to the underlying bill.

The Senate Rules Committee determined it was not. The debate then turned bitter.

Pilcher-Cook challenged the rules committee’s determination — a relatively rare move, especially for a member of the majority party.

That forced the Senate to vote on whether to uphold the rules committee’s determination, which it did 22-15.

Some of the senators who voted against the rules committee, including Sen. Forrest Knox, a Republican from Altoona, suggested the committee was trying to avoid a vote on Medicaid expansion rather than uphold the rules.

Senate Vice President Jeff King, chairman of the rules committee, responded by emphasizing that the determination was unanimous.

The subtext of that was clear: Since a hospital in his district closed last year, King has pushed for an open legislative debate on how to find a “Kansas solution” that would draw down the federal Medicaid expansion money. That places him at odds with fellow Republicans like Pilcher-Cook and Knox who have expressed no willingness to cede an inch on anything connected to Obamacare.

By stressing that the ruling was unanimous, King was signaling that he didn’t make the call and it wasn’t about anyone’s personal stance on expansion.

Senate Minority Leader Anthony Hensley, the lone Democrat on the five-member rules committee, said in a later interview that the committee didn’t discuss the merits of Medicaid expansion at all when it debated Pilcher-Cook’s amendment. But he did mention during the rules committee discussion that the hospital association’s bill sat in Pilcher-Cook’s committee, and she could schedule a hearing on it whenever she wished.

Photo by Stephen Koranda/Kansas Public Radio After removing Pilcher-Cook as chairwoman of the Senate Public Health and Welfare Committee, Senate President Susan Wagle issued an official statement that said: “Breaking the rules of the Senate and putting senators unnecessarily in a position of choosing between upholding the rules of the body or being seen as supporting Obamacare is unacceptable for any committee chair.”

Why did Wagle remove Pilcher-Cook?

Pilcher-Cook claims Wagle ousted her from the committee because Wagle is a closet Obamacare supporter and not sufficiently conservative.

Five years ago such statements would have sounded outlandish, bordering on absurd. Wagle has been in the Senate since 2001 and has long been considered one of the chamber’s most conservative members.

But the last two elections have moved the Senate further right. Wagle is still plenty conservative for her caucus on most issues, but she has expressed some openness to revising Gov. Sam Brownback’s controversial business tax exemption passed in 2012. Years ago Wagle made statements similar to the ones King is making now about finding a “Kansas solution” on Medicaid expansion.

Wagle has tempered those positions with talk of disliking Obamacare and liking tax cuts in general. But it’s hard to govern and hold together a caucus.

The fight over Pilcher-Cook’s amendment exposed a rift within the Senate Republican caucus that threatens Wagle’s authority.

When a member of the minority party challenges the rules committee — like Rep. Jim Ward did in the House just one day later — leadership can brush it off as a partisan maneuver. But when a member of the majority party does so, it’s a sign of a power struggle within the party.

Pilcher-Cook’s removal as leader of the health committee has more to do with her role in that power struggle than it does with Medicaid expansion specifically.   

The latest sign of the rift? The Associated Press reported Tuesday that 17 of the 32 Republicans in the Senate — including Senate Majority Leader Terry Bruce — have signed a petition asking Wagle to reinstate Pilcher-Cook as health committee chairwoman.

What does all of this mean for expansion?

Now that Pilcher-Cook is no longer the committee chairwoman, what does that mean for Medicaid expansion? It may clear the way for more discussion of the issue, but probably little more than that, at least for this year.

Even Medicaid expansion’s most ardent supporters privately concede it’s a tough sell this session, with lawmakers scrambling to balance the budget and keep government functioning before facing the voters in the August primaries and November general election.

Kansas Republicans used their opposition to Obamacare as a campaign issue in each of the last two legislative election cycles, and Medicaid expansion is the only part of the law that they actually have much jurisdiction over at the state level.

Expansion advocates are trying to rebrand it as “KanCare expansion” to associate it with Brownback’s Medicaid managed care changes rather than the federal law that President Barack Obama spearheaded.

The hospital association also is stressing that unlike traditional expansion under “Obamacare,” its plan is a budget-neutral remix similar to red-state models like Indiana’s.

The association is trying to build grassroots support through forums like one scheduled for March 2 in Topeka.

But rebranding and building support takes time. Until they have their ducks in a row, expansion supporters don’t want any negative votes that could stop any momentum they’re finally starting to generate.

Even so, they wouldn’t mind the opportunity to make their case in a public hearing.

That could be more likely now that Pilcher-Cook isn’t running the Senate health committee. Sen. Michael O’Donnell, the interim chair, said Monday that he planned to continue with the light agenda Pilcher-Cook set for this week, then look to Wagle for guidance as to whom she will pick to lead the committee on a permanent basis.

Whoever ends up with the job will decide whether to schedule hearings on expansion and a host of other issues like medical marijuana, licensure requirements for massage therapists, prohibiting minors from using commercial tanning beds and an AARP-sponsored caregiver bill.

On O’Donnell’s first day, Haley already was pressing him for hearings on medical marijuana.

But even if Medicaid expansion gets a committee hearing and the testimony for it is compelling, it remains a long shot this year.

Wagle has promised a Senate vote, but only in order to mollify Senate Republicans who want to reiterate their opposition to Obamacare with a “no” vote before heading home to campaign for re-election.

The hospital association is urging Kansans to contact their legislators in advance of that vote. But absent an overwhelming groundswell of support from the general public, even Hensley said expansion probably will have to wait until after the election.

“It might be able to pass in the House, but I don’t foresee that it’s going to have the votes to pass in the Senate, because it’s such a political football,” Hensley said. “It’s Obamacare.”