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Medicaid expansion bill introduced

Wichita Democrat introduces bill to sync Kansas Medicaid eligibility with the Affordable Care Act

By Mike Shields | January 22, 2013

A Wichita Democrat has introduced legislation that would expand eligibility for the Kansas Medicaid program to include people earning up to almost $15,000 a year.

Currently, the Kansas program is among the most restrictive in the nation and generally covers only children, pregnant women or disabled persons who are poor.

If House Bill 2013 becomes law, the expansion would occur in January 2014, when the the federal Affordable Care Act makes available additional federal funding to cover most of the added program costs.

'A good idea'

Rep. Jim Ward said his proposal, among other things, would assure that Kansans get full value from the federal tax dollars they pay.

Rep. Jim Ward, D-Wichita

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"It's a good idea because it will save lives," Ward said. "No one will argue that people with health insurance live longer and healthier lives and Kansas taxpayers are already paying for the program when they send in their federal tax dollars."

The Affordable Care Act, commonly referred to Obamacare, was written with the intention that Medicaid eligibility would be expanded to include persons nationwide earning up to 133 percent of the poverty level, or about $25,000 a year for a family of three.

But the U.S. Supreme Court ruled in June 2012 that each state has the option to not expand Medicaid should its policymakers, for whatever reason, choose against it.

Gov. Sam Brownback, a conservative Republican opponent of the federal law, has not yet said if he will support Medicaid expansion in Kansas. Administration officials have said they are studying the potential costs and hope to have a report ready perhaps as soon as Feb. 1.

Some Republican governors once expected to fight Medicaid expansions in their states - such as Jan Brewer of Arizona of Arizona - are now saying they will support it or consider it. Governors in 18 states have signaled they will expand their programs; 10 have said they will not, and almost half apparently are undecided.

Shifting costs

Ward said if Kansas doesn't expand the program, the cost of covering the uninsured will be passed along to those who have health insurance in the form of higher premiums.

Under the Affordable Care Act, hospitals are scheduled to lose some of the federal aid (known as disproportionate share payments) they currently receive to compensate for charity care they provide. The decrease was slated to coincide with a nationwide Medicaid expansion with the assumption that uncompensated care from hospitals would drop significantly because most people would be covered.

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Frankie Forbes

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As a result, Medicaid expansion is generally supported by hospital groups, including in Kansas.

"Part of the grand bargain the American Hospital Association made," when the Affordable Care Act was written, "was giving up (disproportionate share payments) for expansion of Medicaid," said Frankie Forbes, an attorney whose firm represents a number of Kansas critical access hospitals and other health care organizations. "It doesn't seem like you can have one without the other, because the cuts (in disproportionate share payments) are coming. You can't get blood out of a turnip."

Forbes also is president of the Kansas Association of Hospital Attorneys.

Ward's proposed bill has been referred to the House Social Services Budget Committee, which is chaired by Rep. Brian Weber, a Dodge City Republican. A hearing on the bill is not yet scheduled.

Competing estimates

Currently, there are several competing estimates of how Medicaid expansion in Kansas would affect Medicaid enrollment and the cost of the program. The latest, released earlier this month by the Kansas Health Institute indicated that approximately 240,000 additional low-income, disabled and elderly Kansans would enroll in a program that currently serves about 380,000. According to the KHI analysis, expanding Medicaid would cost the state an additional $519 million between its implementation in 2014 and 2020.

The KHI projections are higher than those in a 2010 report prepared for the now defunct Kansas Health Policy Authority and also higher than those in a state-by-state analysis done in 2010 by the Kaiser Family Foundation. However, they are considerably less than those estimated in 2011 by the Kansas Policy Institute, a conservative think-tank based in Wichita, which has opposed the Affordable Care Act.

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