Kansas Senate votes to expand Medicaid

March 27--TOPEKA -- The Kansas Senate voted to expand Medicaid on Monday, days after Congress abandoned legislation that would have blocked expansion.

Senators voted 25-13 to give early approval to expansion, with a final vote expected Tuesday. The House has already passed the bill.

Gov. Sam Brownback signaled a likely veto if the bill goes to his desk. A spokeswoman issued a statement critical of expansion as senators debated.

The failure of the federal effort to repeal the Affordable Care Act hung over the debate. Supporters of expansion cheered the decision in Congress. But senators opposed to expansion said they would continue to fight growth in government and suggested federal changes to health care law may still come.

"I've said we can't get distracted by the political gridlock in Washington, D.C. We have to do what's right for the people of Kansas. And what's right, obviously, is to pass Medicaid expansion on our own terms and make sure we cover the 150,000 Kansans that don't have health coverage," said Senate Minority Leader Anthony Hensley, D-Topeka.

Senate President Susan Wagle, R-Wichita, said Kansas is considering entering into a contract with a partner -- the federal government -- that cannot pay its bills. She said she has no confidence that the ACA will continue in its current form.

"We have a new president. If Hillary Clinton were elected, possibly we could be negotiating this bill. But that's not the situation we are in," Wagle said.

One of 19 states

Kansas is one of 19 states that have not expanded Medicaid. Expansion is allowed through the Affordable Care Act to cover people who earn too little to buy insurance through the federal health care exchange but too much to otherwise qualify for Medicaid.

The legislation in the Senate would expand eligibility for the program for people with incomes of up to 133 percent of the federal poverty line, which is $24,600 for a family of four.

The federal government covers 90 percent of the cost of expansion, while the states pay the remaining 10 percent.

The vote marked the first time since the Affordable Care Act became law in 2010 that Medicaid expansion was on the verge of clearing both the Kansas House and Senate. Before this year, neither chamber had voted to advance expansion.

Elections last fall swept a number of moderate Republicans and Democrats into office, giving supporters of expansion a boost.

At legislative hearings earlier this year, supporters of expansion vastly outnumbered opponents.

"A host of individuals supported it. But then the opponent testimony, we find four opponents," Sen. Vicki Schmidt, R-Topeka, said.

Sen. Oletha Faust-Goudeau, D-Wichita, said every place she goes, people ask her when Kansas will expand Medicaid.

"We can pass the buck, we can wait on the federal level to do what they're going to do, or we can do it ourselves. We can help people," Faust-Goudeau said.

Possible veto?

If the bill passes during a final vote on Tuesday, it will go to Brownback for his signature or veto. The House passed the bill 81-44.

The governor has been critical of expansion, and his spokeswoman talked about the bill in terms that suggest a veto.

"To expand ObamaCare when the program is in a death spiral is not responsible policy. Kansas must prioritize the care and service of vulnerable Kansans, addressing their health care needs in a sustainable way, not expanding a failing entitlement program to able-bodied adults," Melika Willoughby said.

The House vote and the initial Senate vote are just shy of the number needed to override a veto. Override takes 84 votes in the House and 27 votes in the Senate.

Brownback could have expanded Medicaid on his own. But he signed a bill in 2014 that required legislative approval of expansion. Supporters now say that Brownback should weigh that heavily if the Senate passes the bill.

State Sen. Barbara Bollier, R-Mission Hills and a retired physician who supports expansion, said it could be several years before Congress makes significant changes to health care law.

"We're talking about real people who need access to care," Bollier said.

Failed amendments

During the debate, conservatives attempted to stop expansion through a series of amendments. Senators voted down the proposed changes.

One amendment would have prevented Medicaid dollars from going to Planned Parenthood. Another would have required the state to prioritize services for Medicaid patients based on need.

An amendment from Sen. Dennis Pyle, R-Hiawatha, would have kept residents in cities that don't fully assist the federal government with immigration enforcement from being eligible for expanded Medicaid. His idea was voted down 13-25.

Conservative Republicans said they opposed the bill even after the federal changes failed Friday.

"We're standing at an amusement park ride that's closed. It's broken. And we're saying we want to go ahead and get on the ride," said Sen. Ty Masterson, R-Andover.

Pyle acknowledged that the congressional bill's failure to get a vote did take an argument away from expansion opponents. But he said he opposes expansion because he opposes growing government.

"I just think it's more government," Pyle said. "We have to look at things from that standpoint."

Contributing: Bryan Lowry and Hunter Woodall of the Kansas City Star

Jonathan Shorman: 785-296-3006, @jonshorman

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