Kansas lawmakers take big step toward expanding Medicaid

March 20-- Mar. 20--TOPEKA -- Kansas lawmakers took a major step Wednesday toward expanding Medicaid, a change that could extend health coverage to 150,000 Kansans but potentially cost $47 million a year.

Lawmakers, ignoring Republican objections, forced the House to debate Democratic Gov. Laura Kelly's Medicaid plan and advanced it on a 70-54 vote.

"This is a big day in Kansas. Although it's not all the way through the process, it's gotten through the House of Representatives, who represented the wishes of the people of Kansas," said Rep. Kathy Wolfe Moore, a Kansas City Democrat who led the charge to pass expansion.

She called the plan critical for Kansans and Kansas hospitals.

Medicaid expansion will head to the Senate after a final vote Thursday. But its fate is far from clear.

The Senate's most powerful Republican, Senate President Susan Wagle, opposes expansion. And legislative procedures make it difficult for senators to force an up or down vote on the bill without the support of Republican leaders.

Lawmakers have been debating Medicaid expansion for nearly a decade. Wednesday's debate fell along familiar lines, but the stakes were higher.

Both supporters and opponents know that Kelly is almost certain to approve a plan if it reaches her desk. It's one of her top priorities. That's a change from past years; Gov. Sam Brownback vetoed expansion in 2017.

Supporters say Medicaid expansion will improve the health of tens of thousands of Kansans by providing access to medical care.

Rep. Tom Cox, R-Shawnee, referenced a childhood illness and said he was lucky to have access to health care, but that many people in Kansas do not. Expansion will be life-changing for more people than lawmakers realize, he said.

"Medicaid expansion to me is not just an ideological thing ... it's about real people's lives," Cox said.

Opponents fear the federal government, which pays 90 percent of the cost, will stop supporting the program in the future.

"It's going to happen. It's a question of when. And the when will be when our federal deficit finally becomes unsustainable," Rep. Steve Huebert, R-Wichita, said.

The plan expands eligibility for medical assistance to all adults who are under 65 and don't make more than 133 percent of the federal poverty level, or $16,611.70 for an individual. Seniors are already covered by Medicare and pregnant women by Medicaid. Expansion would begin Jan. 1, 2020.

The plan also allows the state to create a health insurance premium assistance program for people who make less than 133 percent of the federal poverty level and are eligible for insurance through an employer but can't afford to pay.

Under the Affordable Care Act, the federal government pays 90 percent of the cost of expansion. States pay the remaining 10 percent.

Kelly's budget office places the state cost of expansion at about $33 million a year. A Kansas Health Institute estimate places the annual cost at about $47 million.

Lawmakers amended the plan to require Kansas to end expansion if the federal match rate falls below 90 percent. Lawmakers also voted to require Medicaid expansion recipients to pay a $25 per month premium, but added that no family would pay more than $100 a month.

The House also approved an amendment to prohibit any Medicaid expansion dollars from being used for abortions.

Lawmakers clashed over whether expansion -- and the money it's expected to pump into the healthcare system -- will help rural hospitals. Several rural hospitals in Kansas have closed over the past few years.

In 2015, a hospital closed in Independence. Last year, a Fort Scott hospital ended its operations. A hospital in Horton closed in the last few weeks.

"We, I feel, are moving into a danger zone in rural Kansas," Rep. Jim Kelly, R-Independence, said.

House Majority Leader Dan Hawkins, R-Wichita, said healthcare has changed in rural areas. In some small communities, hospitals have become hard to support, he indicated.

"Expansion's supposed to stop that -- it's not. It hasn't in other states," Hawkins said of hospital closures.

While many lawmakers have strong feelings about expansion, others agonized over how to vote.

Rep. Mark Samsel, a Wellsville Republican, said Republicans and independents in his district are split over expansion, but that Democrats support it.

"There's problems with this bill and the costs associated with it," Samsel said. "There's also positives."

Wednesday's debate took place only after expansion supporters, fearing they wouldn't have another chance, amended the expansion bill onto legislation about advanced practice nurses. To do that, they had to overrule Republican leaders, who said the amendment wasn't closely related to the original bill.

The amendment replaced the contents of the original bill with the expansion bill, a move known as "gut and go." Lawmakers have faced criticism in recent years over that procedure because it can be used to bypass normal vetting of legislation and can obscure the source of bills.

Rep. Brenda Landwehr, R-Wichita, said lawmakers who supported the gut and go had been previously quoted in articles opposing the tactic. She had urged lawmakers to take a few more days to work on the legislation.

Wolfe Moore said expansion supporters would not have gutted the bill "if I felt there was another path to Medicaid expansion."

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