Kansas Bill Gives Medicaid Expansion Some Hope

Medicaid expansion has been a top priority for Kansas Democrats, notably Gov. Laura Kelly, who have argued it will be a boon not just for the estimated 145,000 Kansans who could gain coverage but also for hospitals. Most Republicans in the state are skeptical of the proposal and its potential long-term costs for the state.

A bill introduced in Congress last week to let cities and counties opt in to expand Medicaid is gaining attention from advocates in Kansas, who have long pushed for increase eligibility in the program statewide, a plan which has been thwarted by legislative Republicans.

But others caution the measure isn't a panacea, especially given its uncertain path forward in Washington. And it would likely not help rural parts of the state, which expansion proponents have long argued to be the main beneficiaries of increased eligibility.

Nationally, 12 states haven't expanded Medicaid, increasing the income cap for the program targeted at low-income residents – an option available under the Affordable Care Act.

A protracted court battle is expected in Missouri after legislators opted not to follow through on expansion, despite a referendum on the matter passing last year.

The expansion fight in Kansas has been ongoing for years, with most Republicans in the state skeptical of the proposal and its potential long-term costs for the state.

It has been a top priority for Kansas Democrats, notably Gov. Laura Kelly, who have argued it will be a boon not just for the estimated 145,000 Kansans who could gain coverage but also for hospitals, particularly in rural areas or those near Nebraska or Colorado, both states which have implemented Medicaid expansion.

While prospects looked promising in 2020 for an expansion deal after Kelly and then Senate Majority Leader Jim Denning reached a compromise on the matter, the proposal ultimately didn't have enough votes to pass the Kansas Senate.

A host of pro-expansion Republicans were voted out in the 2020 elections, taking the subject off the table in the 2021 session.

Bill would create five-year

expansion option for counties, cities

But advocates are intrigued by the idea of giving local governments the opportunity to, in effect, do an end-around the state Legislature.

The legislation, introduced by U.S. Rep. Lloyd Doggett, D-Texas, would give local governments the same deal offered to states under the Affordable Care Act, with the federal government picking up 100% of costs in the first three years, with a gradual reduction in the share covered by Washington, D.C., thereafter.

"For many of our most disadvantaged citizens this bill offers a pathway to access a family physician, necessary medicine, and other essential coverage that thirteen States continue to deny," Doggett said in a statement. "The COVER Now Act empowers local leaders to assure that the obstructionists at the top can no longer harm the most at-risk living at the bottom."

Cities, counties and hospital districts can contract directly with the Center for Medicaid and Medicare Services to plan out a potential expansion effort, which would last five years and could be renewed. Multiple cities or counties could even band together and apply regionally, something which may be attractive for governments in the Kansas City, Kan., area.

States would be required to work with any local governments which opt to expand. CMS could offer additional federal funds for states which cooperate – or choose to fine those who don't.

The program is based on a pilot program in Cleveland, where the county effectively expanded Medicaid for 30,000 residents, months before Ohio opted to expand coverage statewide.

The bill had 42 Congressional Democrats sign on in support, all from states that have yet to expand Medicaid. Kansas' lone Democrat in the U.S. House, U.S. Rep. Sharice Davids, didn't sign on initially and a spokesperson didn't immediately return a request for comment on whether she planned to support the measure.

Kansas advocates 'applaud'

proposal — but questions remain

The proposal currently left more questions than answers, said April Holman, executive director for the pro-expansion Alliance for a Healthy Kansas, but she said her group would "applaud" the effort to think outside the box to provide more coverage for working-class residents.

But the effort wasn't a substitute for statewide expansion, she added.

"It seems like in Kansas, we will make things as complicated as they can possibly be, instead of just taking the very simple route of expanding," Holman said.

Holman said it was difficult to tell how many states could stomach the eventual 10% match required to secure federal funding, even if a local government was broadly interested in expansion.

The bill could also be used as an excuse by state legislators to avoid statewide expansion, she added. And the fact that only the state's core urban and suburban areas, such as Kansas City, Kan., Wichita and Johnson County, would likely opt to expand would leave rural areas behind.

But Sen. John Doll, R-Garden City, a longtime proponent of expansion, said he thought counties in his western Kansas district would take a hard look at the concept, if the bill were to pass in Washington.

Eight of the counties in his region have county hospitals underwritten by local property tax revenue and services provided to uninsured residents ultimately affect taxpayers, he said.

"I think it wouldn't be that hard of a sell," Doll said. "There again, it would depend on the match ... if they can pencil it out and see that this match would save the money on the county hospital, I think they would be all in."

Biden administration likely

to continue expansion pressure

Doggett has said he hopes to pass the bill by a process known as reconciliation, which would mean the legislation would only need a simple majority in the U.S. Senate – something which would greatly increase its odds of passing that chamber.

It is unclear if his colleagues in the U.S. House share an interest in pursuing the measure. If passed, it would likely come under heavy fire from conservatives, particularly in the 12 states without expansion, and could be subject to a legal challenge.

Even if it doesn't move forward, however, there will likely continue to be an interest from Congress and President Joe Biden's administration to induce the holdout states to pursue expansion.

The Biden administration, for instance, is threatening not to renew a key Medicaid waiver for Texas – potentially costing the state billions of dollars – in an effort to force it to expand.

"The bottom line is that there's a huge problem," Holman said. "And we're really relieved there is attention to that issue. And I hope that they're going to be solutions that come out."

Medicaid expansion has been a top priority for Kansas Democrats, notably Gov. Laura Kelly, who have argued it will be a boon not just for the estimated 145,000 Kansans who could gain coverage but also for hospitals. Most Republicans in the state are skeptical of the proposal and its potential long-term costs for the state.