Topeka Thousands of poor families don't know whether they will get state aid they have been promised to help them buy insurance because the House and Senate still disagree on health care legislation.
Legislators created the subsidy program last year and planned to start providing aid in 2009. Initially, it would go to 8,500 parents whose household incomes are 50 percent or less of the federal poverty level, or $8,800 for a single parent with two children.
But the Senate gave first-round approval Tuesday to a bill postponing the subsidies indefinitely, rejecting four attempts to see that the aid starts flowing next year. Senators planned to take a final vote today to determine whether the bill goes to the House.
Senate Republican leaders are nervous about the potential cost of the insurance subsidies to the state.
"We can't afford it," said Senate Majority Leader Derek Schmidt, an Independence Republican. "When we made the decision last year, we committed ourselves to something that we are not going to be in a position to deliver."
But in the House, leaders in both parties brokered a deal to make sure that poor families get at least a year's worth of subsidies.
The House Health and Human Services Committee drafted a bill that didn't deal with the subsidies, which caused Democrats and some Republicans to worry that legislators would break last year's promise. That led to talks between GOP and Democratic leaders.
The House was supposed to debate the committee's bill Tuesday. But Speaker Melvin Neufeld postponed the discussion until Thursday so amendments reflecting the agreement can be drafted.
"Nobody knew for sure what was going to happen if we ran it on the floor today and let them amend it, helter-skelter," said Neufeld, an Ingalls Republican. "You end up with a real disorganized product."
Democrats had complained that Republicans, who have majorities in both chambers, were ignoring many of the recommendations made by the Health Policy Authority in a 21-point health plan. Democratic Gov. Kathleen Sebelius supports the plan.
Projections for the plan's cost have varied. But the Health Policy Authority estimates that, combined with the subsidy program approved last year, the plan would phase in a $330 million increase in spending on health programs over five years. The subsidies account for nearly three-quarters of the total.
The agreement among House leaders preserves only the first year of the subsidy program, without a guarantee that it would continue.
Under last year's law, additional families would become eligible for aid, so that by 2013, the state would be spending more than $111 million a year to help poor families. The subsidies eventually would be about $2,800 a year per policy.
The Health Policy Authority proposed expanding the program even further to include poor adults without children. Under its plan, the state eventually would provide $241 million in subsidies each year.
The authority also proposed increasing tobacco taxes to help pay for some of the new spending, with the tax on a pack of cigarettes rising on July 1 by 50 cents, to $1.29. Lawmakers haven't seriously considered the idea.
The Legislature created the authority in 2005 to review health care issues and manage some of the state's social service programs. Last year, in bundling the insurance subsidy program and other modest health care initiatives into a single package, lawmakers told the authority to make additional recommendations.
"They put a huge amount of time and money into developing a plan. We shouldn't just throw it out," said House Minority Leader Dennis McKinney, a Greensburg Democrat. "Our interest was in maintaining the bulk of their proposals."
The agreement among House leaders includes 11 of the Health Policy Authority's recommendations, including providing cancer screenings to Kansans and dental services for poor, pregnant women.
The agreement would increase spending on health programs by about $18 million during the fiscal year beginning July 1. Under the Health Policy Authority's plan, the increase would be $23 million.
At Neufeld's urging, the agreement includes provisions to make more pregnant women eligible for the state's medical coverage and to help them quit smoking.
Many of the House committee's proposals would remain, including ones designed to promote health savings accounts.
But the agreement strips out a proposal to provide $9 million in income tax credits over three years to offset insurance costs for families with household incomes of less than $60,000. Instead, the idea would be studied.
"This represents a fair compromise," said Marcia Nielsen, the Health Policy Authority's executive director. "We think it's a good first step, albeit an incremental one, to move Kansas forward on health reform."
The insurance "premium assistance" program legislators approved last year would have been phased in over four years, when all parents whose household incomes are at or below the federal poverty level would qualify. For a single parent with two children, that's $17,600.
The state covers medical services for children in households with incomes up to twice the federal poverty level.
But adults don't qualify unless their incomes are below 37 percent of the federal poverty level - or $6,512 for a family of three. Often, children are covered by the state but their parents aren't.
"I have no problem reaching down in my soul to find that commitment," said Sen. Jim Barnett, an Emporia Republican and physician who wanted to preserve the insurance subsidies.