GOP leaders reject Kan. governor's new proposal for Medicaid expansion

TOPEKA — GOP leadership in the Legislature rejected Gov. Laura Kelly's latest proposal for Medicaid expansion, questioning whether federal regulators would allow a work requirement and calling for alternate reforms without offering their own plan.

Their resistance to Medicaid expansion, which would benefit an estimated 150,000 Kansans with low incomes, stands in contrast to support for the program from rank-and-file Republican lawmakers and a majority of Republican voters.

Kelly attempted to address concerns raised by opponents in the past by including a work requirement in her plan, offsetting the state's cost by taxing the Medicaid funding hospitals receive, allowing individuals to stay on private insurance but receive assistance from the state, and clarifying that abortion services are only covered in cases of rape, incest or to save the life of a mother.

"Cloaked in a fake work requirement and a tax scheme, the governor's proposal to expand the welfare state creates more problems than it solves," said Senate President Ty Masterson, an Andover Republican. "It is poor public policy to push able-bodied adults off of private insurance and onto a government program that was intended for the truly vulnerable."

Most of the Kansans who would benefit from Medicaid expansion are workers with low incomes or suffering from chronic illness. They are small business owners and their employees, as well as students, cancer patients and those who need mental health treatment.

Under current Medicaid rules in Kansas, a single mother working a minimum wage job earns too much to qualify. The Affordable Care Act allows states to expand eligibility to those who earn up to 138% of the federal poverty level. In exchange, the federal government covers 90% of the cost of existing and expanded services. Forty states have expanded Medicaid.

Sen. John Doll, a Garden City Republican who drove five hours to join Kelly for her announcement Thursday, said it was inaccurate to refer to Medicaid as welfare, "but if it was true, so be it."

"And what disturbs me is this is the United States, this is Kansas — if somebody needs health care, they should be able to get health care," Doll said.

House Speaker Dan Hawkins, a Wichita Republican, questioned whether federal regulators in the Biden administration would allow a work requirement to stand. The Centers for Medicare and Medicaid Services have blocked work requirements, which impose an administrative barrier and when allowed in Arkansas had no effect on employment rates.

"While I appreciate the governor's newly found support for work requirements for welfare benefits, this is nothing more than smoke and mirrors," Hawkins said.

Under Kelly's proposal, individuals would have to prove they are working when they first enroll in the program, and again when they renew their enrollment each year. The governor said she doesn't consider the work requirement to be burdensome because every recipient already has to prove income eligibility.

Kelly said this approach was different than other states that required individuals to prove employment every month. Her plan also allows for exceptions for full-time students, caretakers, veterans and those with medical conditions.

Akeiisa Coleman, senior program officer for Medicaid in the Federal and State Health Policy initiative at the Commonwealth Fund, said the work requirement could still be problematic for seasonal workers, such as those who work at harvest time. She said the work requirement in Arkansas resulted in coverage losses without increasing employment, an outcome that could be used to support a legal challenge to a work requirement in Kansas. Coleman also emphasized that almost all of the working-age adults who benefit from Medicaid expansion are already working.

Hawkins and Masterson both said they were interested in giving Kansans more options for health care and lowering costs, but neither has proposed legislation to do so.

"There's one word to describe Republican leadership: Cruel," said House Minority Leader Vic Miller, a Topeka Democrat. "Kansans across the state are suffering and quite literally dying from a lack of health care. Instead of responding with solutions, the Kansas GOP actively mocks these people in the media."

Miller said Republicans could defend their position in a debate, but GOP leaders refuse to allow a discussion on Medicaid expansion.

"Leadership doesn't like when we point out the blood on their hands, but they are solely responsible," Miller said. "Republicans need to stop trading Kansas lives in an attempt to score political points against the governor."

This story is part of "The Holdouts," a reporting collaborative focused on the 10 states that have yet to expand Medicaid, which the Affordable Care Act authorized in 2010. The collaborative is a project of Public Health Watch.