As the Republican-controlled Legislature gets about to convene for its annual session, Democratic Governor Laura Kelly is advocating for Medicaid expansion in Kansas in a more aggressive and overtly political manner.
As the Republican-controlled Legislature gets ready to convene for its annual session on Monday, Democratic Governor Laura Kelly is pushing harder and more overtly politically to expand Medicaid in Kansas. This comes after five years of fruitless attempts to extend state health coverage to an additional 150,000 people. Kelly is up against leaders of the GOP supermajorities, whose top goals are not Medicaid expansion but rather lowering local property taxes and cutting income taxes.
However, Kelly’s new strategy calls for taking a harsh stance against Republicans who oppose expansion later this year in campaigns for legislative seats. This strategy goes against years of self-promotion as a politically indifferent bipartisan problem-solver. In a recent interview, Kelly stated, “My previous approach, which has always been to try to bring people together, work collaboratively, come to a consensus, and then get good policy on the books—that hasn’t worked.” “It might be the solution to take a more aggressive and, to put it bluntly, political approach to it,” she continued.
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Kelly has been traveling the state for months, holding roundtable discussions and press conferences to increase support for Medicaid expansion. She claimed to have based her campaign on that of Democratic Governor Roy Cooper of North Carolina, whose coverage was expanded as of December 1 by a legislature controlled by Republicans. Just ten states, including Kansas, have chosen not to expand Medicaid in accordance with the federal Affordable Care Act of 2010, which provides federal funding to pay 90% of the additional expenses. Top Republicans have indicated a desire to talk about expansion this year in Georgia and Mississippi, two more states, so the subject is not moot.
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In Kansas, conservative opposition is rooted in small-government beliefs and decades of skepticism about social services. In the fall, House Speaker Dan Hawkins and Senate President Ty Masterson, both Wichita-area Republicans, derided Kelly’s events with business leaders, hospital administrators and health advocates as a “Welfare Express Tour” for “more government dependency.”
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“It’s about not using taxpayer dollars to fund free healthcare for a new population of able-bodied, childless adults who don’t want to work,” Hawkins said in an email. For some Kansas residents, the issue is getting by. In Newton, 46-year-old Robyn Adams works 15 to 20 hours a week while she cares for her 15-year-old daughter and uses a manufacturer’s program to avoid paying $1,500 every two weeks for shots to manage her rheumatoid arthritis. She lost Medicaid coverage by working more hours, but not enough to qualify for federal subsidies for private insurance. Even covering a $40 copay before a doctor’s visit can be a financial challenge, so paying a large
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“We need insurance, too,” she said of low-income families. “Without the expansion, I don’t know—a lot of families are going to be in trouble.” To attract GOP votes, Kelly has mandated that those who would newly qualify for Medicaid verify annually that they are working. But Masterson told reporters, “It really doesn’t change the underlying facts.” In Kansas, childless adults without disabilities don’t qualify for Medicaid. Parents like Adams aren’t covered when their household incomes hit 38% of the federal poverty level. For a single parent of one child, it’s less than $7,500; for a family of four, it’s $11,400.
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An expansion would make both groups eligible if they earn up to 138% of the federal poverty level. A single, childless adult could earn $20,100; a single parent and one child, about $27,200; and a family of four, $41,400.
Of the people who would qualify, 73% are in families with at least one full- or part-time worker, according to KFF, the research organization formerly known as the Kaiser Family Foundation. Many work in services and others are independent contractors, said Sean Gatewood, a former Kansas House member and spokesperson for the KanCare Advocates Network, a pro-expansion coalition.
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Kelly’s plan would increase the cost of the Kansas Medicaid program by 31%, or about $1.35 billion a year. However, federal funds would cover all but $135 million, with the state imposing fees on hospitals and large private health insurance companies for most of the rest. The federal government is also offering the remaining non-expansion states another financial bonus. A promise of an additional $1.8 billion over two years was crucial for GOP lawmakers in North Carolina. Kelly’s office expects Kansas to receive a total bonus of between $370 million and $450 million.
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But even if there is enough support to pass a bill expanding eligibility, Hawkins, Masterson and their allies can keep a plan from even clearing committees. Democrats’ attempts to offer expansion plans during debates on other measures have been ruled out of order, and even Republicans backing expansion have stood with their leaders on that point. Yet Kelly and other advocates see plenty of reasons to keep pushing, including North Carolina Gov. Cooper’s success.
Cooper argued GOP lawmakers in his state felt pressure from an unusual coalition that included rural chambers of commerce and “tough-on-crime Republican sheriffs” who felt they were dealing with too many people who simply needed access to health care, “not handcuffs.” As for non-expansion states, Cooper said in a news conference: “I hope that they can take some of the lessons of the coalitions of people that we’ve been able to put together to try to succeed.”
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