Topeka ? Leading health care advocates in Lawrence and throughout Kansas say that after last week’s U.S. Supreme Court decision upholding a key part of the federal Affordable Care Act, there is no longer any reason for Kansas to resist expanding Medicaid.

“Regardless of the decision, there is no reason for Kansas not to expand Medicaid,” Gene Meyer, president and CEO of Lawrence Memorial Hospital, said shortly after the Supreme Court’s ruling Thursday. “Kansas should expand Medicaid.”

So far, however, Republican leaders in Kansas show no signs of softening their opposition.

“We will not spend one more penny fixing Congress’ mistakes, whether that means rejecting Medicaid expansion or a state exchange,” Republican Sen. Mary Pilcher-Cook, of Shawnee, chairwoman of the Senate Public Health and Welfare Committee, said in a statement just before the court’s decision was announced.

The Affordable Care Act, commonly known as Obamacare, was meant to expand access for all Americans to affordable health care coverage. It requires nearly all Americans to carry a certain level of health coverage or pay a tax penalty. It also provides several ways for people to acquire coverage.

One provision, which the Supreme Court upheld last week, provides subsidies in the form of tax credits for people who can’t otherwise get insurance through their employer to buy policies through online marketplaces known as health care exchanges.

Another mechanism originally required states to expand their Medicaid programs to cover all individuals in households with incomes up to 138 percent of the poverty level, with the federal government paying nearly all of the cost of expanding coverage.

That would cover individuals with incomes up to $16,105 a year, and $32,913 for a family of four.

In 2012, the Supreme Court upheld the individual mandate. But it said Medicaid expansion must be optional for states because the federal government could not compel states to participate.

Since then, Republican Gov. Sam Brownback and the GOP-led Legislature have all refused to expand the state’s Medicaid program, now known as KanCare.

During the 2015 legislative session, three Medicaid expansion bills were introduced. One, by Lawrence Republican Rep. Tom Sloan’s Vision 2020 Committee, would have funded the state’s share of the cost through an assessment on health care providers.

“I sent a message to the Governor’s key staff members earlier (Monday) suggesting that because of the state’s revenue issues, Congress’ inability to modify the Affordable Care Act, and two Supreme Court decisions that it is time to look at HB 2270 because it offers a Kansas solution — accountability by providers, innovative pilot delivery systems, and no cost to (the state general fund),” Sloan said in an email Monday.

“I have not heard back and probably will not,” he said, adding: “Yes, it is time for the Administration to actively develop a strategy to expand Medicaid/KanCare.”

Another bill, introduced at the request of the Kansas Hospital Association, would have authorized the Department of Health and Environment to seek a federal waiver so that Kansas could design a Medicaid expansion plan of its own.

KHA spokeswoman Cindy Samuelson said expanding Medicaid could be a matter of survival for many hospitals, especially rural hospitals that serve smaller populations. That’s because the ACA calls for offsetting the higher federal cost of Medicaid with reduced payments to hospitals through Medicare, the federal health insurance program for the elderly.

“Hospitals took big cuts with the thought that more people would be insured,” Samuelson said.

The third bill, offered by Democratic Rep. Jim Ward, of Wichita, simply would have expanded Medicaid as provided under the federal law.

Ward said last week that the Supreme Court’s decision should increase pressure for Kansas to expand Medicaid, and not just because of pressure from hospitals and health care providers.

“The moral issue of telling people they can’t have insurance, and the fact that, overwhelmingly, states have signed up, it has produced results and it has provided coverage,” Ward said. “Kansas is an outlier right now.”

Brownback’s press secretary, Eileen Hawley, told The Associated Press last week that Brownback still opposes expanding Medicaid because the state still has waiting lists for elderly and disabled people who already qualify to receive certain kinds of Medicaid services.