Kansas Senate advances Medicaid expansion bill

Sens. Mary Pilcher-Cook, left, and Vicki Schmidt debate a bill that would expand the Kansas Medicaid program known as KanCare under the federal Affordable Care Act, Monday, March 27, 2017 at the Kansas Statehouse in Topeka.

? A bill that would expand the Kansas Medicaid program under the federal Affordable Care Act moved closer to final passage Monday, three days after an effort to repeal that federal law, also known as Obamacare, fell apart in Congress.

But the 25-13 vote that sent the bill on for final action Tuesday was two votes short of the two-thirds majority needed to override a virtually certain veto by Republican Gov. Sam Brownback.

Assuming it passes a final vote Tuesday, it would go directly to Brownback’s desk because the Senate made no changes to the House bill.

Brownback’s office, however, issued a statement indicating he has not changed his long-standing opposition to Medicaid expansion.

“To expand ObamaCare when the program is in a death spiral is not responsible policy,” Brownback’s spokeswoman Melika Willoughby said in a statement posted on Twitter. “Kansas must prioritize the care and service of vulnerable Kansans, addressing their health care needs in a sustainable way, not expanding a failing program to able-bodied adults.”

The bill would extend coverage under the state’s Medicaid program known as KanCare to an estimated 150,000 Kansans who are in what is called the “coverage gap,” meaning they currently earn too much to qualify for standard Medicaid but don’t earn enough to qualify for subsidized individual coverage offered through the exchange markets. It would raise the eligibility limit in Kansas to include anyone in a household with income up to 138 percent of the federal poverty level, or $28,180 a year for a family of three.

Under the Affordable Care Act, the federal government pays 90 to 95 percent of the cost of covering those people who become newly eligible. The bill, however, would end the program if the federal matching rate ever falls below that level.

Currently in Kansas, the only adults under age 65 who are eligible for Medicaid are parents and caregivers with incomes below $7,644 a year for a family of three, or roughly 37 percent of the federal poverty level. The federal government pays 55 percent of that cost while the state of Kansas pays 45 percent.

Childless adults do not currently qualify for Medicaid in Kansas.

The Senate’s vote to advance the bill toward final action came after supporters beat back several amendments by conservatives who opposed the legislation.

The one amendment that came closest to passing was by Sen. Mary Pilcher-Cook, R-Shawnee. It appeared aimed at making sure that Planned Parenthood would not be eligible to provide family planning services under the expansion. That proposal failed on a vote of 18-20.

Supporters also defeated a proposed amendment by Sen. Dennis Pyle, R-Hiawatha, that would have denied eligibility under the expansion program to any resident of a so-called “sanctuary” city or county. That amendment failed, 13-25.

There were differing estimates about how much the expansion plan would cost. The Kansas Department of Health and Environment estimated it would cost the state roughly $81 million a year. But the Kansas Hospital Association claims it would actually have a net positive effect on the state budget because it would boost employment in health care-related fields and provide other economic stimulus in Kansas.

Senate President Susan Wagle, R-Wichita, urged her colleagues to vote against the bill, saying she has no faith that the federal government will be able to keep up its end of the bargain.

“The federal government becomes our partner when we pass this bill, and the federal government cannot pay its bills,” Wagle said, adding that she thought the Legislature should wait until Congress and President Donald Trump reach an agreement on either repealing or amending the current federal law.

“We have a new president,” she said. “If Hillary Clinton were elected, possibly we could negotiate this bill. But that’s not the situation we are in.”

But Sen. Vicki Schmidt, R-Topeka, who supported the bill, said she saw no point in waiting on action from Washington.

“I think they had an opportunity this last weekend and they didn’t take it,” Schmidt said. “I do believe, however, that with this new president we should be able to negotiate more flexibility. With a Republican Congress and a Republican president, we should be able to negotiate more flexibility, and I want to be in line for that.”

Newly-elected Sen. Ed Berger, R-Hutchinson, said he supported the bill because of the number of people it would cover, and the number of struggling rural hospitals in Kansas that would benefit from the expansion.

“I have a hospital in my district, and we passed a three-quarter of a cent sales tax so it could stay open,” Berger said. “If we had expanded KanCare, that tax would not have to have been passed.”

The Senate will take a final vote on the bill when it convenes at 10 a.m. Tuesday.