Topeka — Kansas continues to reject expansion of Medicaid.

Last week, the Senate approved a bill, 33-7, that said the state couldn’t expand Medicaid under the federal Affordable Care Act unless the Legislature approves the policy. That reiterates a policy that was adopted last year.

And the House has approved a bill that would remove Kansas entirely from the ACA and allow the state to join a multistate compact to handle federal health care dollars. A Senate committee hearing approved that bill Tuesday.

Meanwhile, 26 states and the District of Columbia have opted into Medicaid expansion in line with the ACA. Five other states are in various stages of debating or negotiating a way to expand.

Nineteen states, including Kansas, are not moving forward on it.

The state Senate vote came just days after a couple of hundred people gathered in the Statehouse and urged legislators to expand Medicaid.

Some of those people met with House Minority Leader Paul Davis, D-Lawrence, who is a candidate for governor.

Later Davis said, “This is an important issue to Kansas. If the state elects not to do this, we are really jeopardizing a lot of hospitals and health care providers.” Hospitals have argued that without expansion, they will continue to have to provide uncompensated care to many people.

But Brownback and Republican legislative leaders, who have adamantly opposed the ACA, have rejected the proposal.

State Sen. Mary Pilcher-Cook, R-Shawnee, chairwoman of the Senate Public Health and Welfare Committee, said the ACA “creates dependencies” and a “permanent underclass.”

Medicaid provides health coverage for the needy and disabled. Under the ACA, federal funds would pay 100 percent of the cost of expansion for three years and no less than 90 percent after that.

Supporters of expansion of Medicaid say it would help thousands of Kansans who earn too much to be eligible for either Medicaid or to receive premium tax credit assistance under the ACA to purchase private insurance.

There are 182,000 Kansans within that gap, according to a study by the Kansas Health Institute. Of that number, 78,400 have no insurance, the study said.