Topeka — Gov. Sam Brownback is taking a wait-and-see attitude about whether to opt-in to expansion of the Medicaid program under the federal Affordable Care Act.

“We’re talking with other states about what they are doing, still reviewing options,” Brownback said recently.

And like all things related to the ACA, sometimes called, “Obamacare,” politics is involved. A handful of states, all led by Republican governors and outspoken critics of the Affordable Care Act, have ruled out expansion of Medicaid. Those states, which include Texas, Oklahoma, Georgia, Mississippi and South Carolina, have among the highest rates of uninsured citizens in the country.

Currently, Medicaid provides health care coverage to about 380,000 Kansans, with the largest portion of them — about 230,000 — being children. The rest are mostly lower-income, pregnant women, people with disabilities and the elderly. The $2.8 billion program is funded with federal and state dollars.

Medicaid in Kansas doesn’t cover low-income adults who don’t have children. And a nondisabled adult with children is eligible only if his or her income is below 32 percent of the poverty level, which is approximately $5,000 per year. That is about the most difficult eligibility level in the country.

But starting in 2014, the ACA creates an eligibility level of 138 percent of the federal poverty level, which is $15,415 per year for an individual and $26,344 per year for a family of three.

Estimates indicate that Kansas’ Medicaid enrollment would increase by 135,000 people under the new rules. In addition, many more children probably would be helped, because when parents have access to insurance, it is more likely their children will, too. Estimates show that about 70 percent of Kansas children currently without health insurance actually are eligible for Medicaid but are not enrolled.

If Kansas opts for the expansion, the federal government would pay for 100 percent of the additional cost for three years starting in 2014. Then the federal share would drop to 90 percent by 2020.

Some health care experts have argued that states would be foolish to pass this up. It would provide coverage to people who are currently uninsured and help hospitals that are struggling to care for those people now.

But some governors, Democrats and Republicans, say they are wary that the federal government, as it grapples with budget problems, will put states on the hook for increased expenses.

Shannon Cotsoradis, president and CEO of Kansas Action for Children, disagrees. Kansans already are paying for the health care of the uninsured, she said, whether it’s in the form of higher hospital costs or premiums.

“The costs of the uninsured are just hidden now,” she said.

She said expanding Medicaid will provide cost-effective preventative care for thousands of Kansans. And, she argued, if Kansas doesn’t participate, the state’s taxpayers are leaving money on the table to help other states.

Cotsoradis said she believes some governors are waiting to see whether the federal government will provide any more flexibility in the program’s expansion before they commit.