Medicaid expansion backers in Kansas may hold budget hostage

TOPEKA, Kan. (AP) — Advocates for expanding Medicaid in Kansas are looking to block passage of the state's next annual budget to force an expansion plan through the Republican-controlled Legislature over conservative leaders' objections.

Legislators reconvened Wednesday after an annual spring break, and the state Senate rejected an effort by its top Democrat to expedite an expansion debate. The Senate has yet to act on a measure approved by the House in March, and top Republicans want to delay action until next year.

The next Senate vote was 23-13 on pulling an expansion bill out of the committee where it's been stuck for weeks, one short of the 24 votes supporters needed under the chamber's rules. Even before the vote, expansion supporters were focusing on the alternative of tying up the $18 billion-plus budget that lawmakers must pass to keep state government operating after June.

"It's the best leverage we have right now," said House Minority Leader Tom Sawyer, a Wichita Democrat. "There's been a lot of discussion."

Medicaid expansion is one of new Democratic Gov. Laura Kelly's priorities and its approval would be her biggest victory so far in her first months in office. Expansion has enjoyed bipartisan support for at least several years, but Kelly's conservative Republican predecessors were vocal critics of the 2010 federal Affordable Care Act that encouraged it.

During an Associated Press interview, Kelly brushed aside top Republicans' concerns about needing more time to consider the details of an expansion as "just a stall tactic." She said he doubted that lawmakers could draft a better plan with more time.

"It is very clear that a strong majority in the Kansas Senate support Medicaid expansion and want the opportunity to debate and vote on it this year," Kelly said after the vote. "Now is the time to get it done."

A small group of expansion supporters stood outside the entrance to the Statehouse parking garage Wednesday morning, holding signs and chanting, "Health care is a human right! Expand Medicaid now!" Advocates have been pushing for an expansion for at least five years.

Still, top Republicans argue that Kelly is trying to rush the debate and that they want to avoid pitfalls that could drive up the state's costs.

"It needs a lot of due diligence and structure to protect the patients as well as the taxpayers," said Senate Majority Leader Jim Denning, a conservative Kansas City-area Republican.

Kelly's plan for expanding Medicaid health coverage to up to 150,000 additional Kansas residents is based on a bill that passed in 2017 with bipartisan support, only to be vetoed by then-Gov. Sam Brownback, a Republican.

Denning called the House-passed expansion bill "regurgitated" and said the state needs policies in place to curb health costs and encourage Medicaid participants to seek preventative care. GOP lawmakers also have mentioned imposing work requirements and even drug testing.

Denning said he agrees with Kelly that expansion "is inevitable" but added, "She's going to have to wait, I hope, until the second year so we can do the massive and complicated plan correctly, rather than in a rush."

The Affordable Care Act was Democratic former President Barack Obama's signature domestic policy and it encouraged states to expand Medicaid by promising that the federal government would cover most of the cost. Thirty-six states have expanded Medicaid or seen voters approve ballot initiatives.

Kelly's administration has projected that the first full year of Kansas' expansion would come with a net cost of $34 million to the state. Some supporters believe the influx of federal dollars will spur economic activity, generate new state tax revenues and offset those costs. Many Republicans are skeptical and believe the state's next costs could be much higher.

The Senate's top Democrat, Minority Leader Anthony Hensley, of Topeka, tried to pull the expansion bill from a Senate committee.

Democrats hold only 11 seats in the Senate and were forced to rely on Republicans to bypass the normal committee process. It was a tough sell to some moderate GOP senators who lead committees themselves and don't want to face a similar tactic in the future.

"This issue's not going to go away," Hensley said after the vote.

Blocking the budget is "all we have left," said Rep. Susan Concannon, a moderate Republican and expansion supporter from western Kansas.

"If we support Medicaid expansion, that's our leverage," she said.

Follow John Hanna on Twitter at https://twitter.com/apjdhanna .