Topeka A standing-room-only crowd packed into a Statehouse committee room Wednesday, with dozens more forced to sit outside, to offer testimony in support of expanding the state's Medicaid program to provide health coverage to an estimated 145,000 additional Kansans.
A similar bill passed both chambers of the Legislature in 2017, but supporters fell a few votes short in the House of being able to override a veto from then-Gov. Sam Brownback, who has since resigned.
But even though his successor, Gov. Jeff Colyer, remains opposed to the idea — and there have been efforts in the Republican-controlled Congress in Washington to repeal a portion of the Affordable Care Act that authorizes expansion — supporters remain hopeful that they can force through a bill in Kansas in 2018.
"The Medicaid expansion has not been repealed at the federal level, and it doesn't look like it's going to be," Sheldon Weisgrau, acting director of the advocacy group Alliance for a Healthy Kansas, told the committee. "And a big part of that is because of Republican governors lobbying to keep it because it's helping their states."
The most impassioned testimony, though, came from Amy Houston, a small business owner from Mulvane, who told of the troubles she experienced keeping private health insurance while battling cancer.
Houston said she was diagnosed with Hodgkin lymphoma at the age of 28. It forced her to sell the restaurant that she had established a few years earlier, but she continued to work 50 hours a week at a corporate job because it offered health insurance.
When she began daily radiation therapy, however, she was forced to leave that job, and she soon found herself without any kind of coverage, unable to qualify for Medicaid, and facing a rising volume of medical debt that she said severely damaged her credit rating.
She eventually acquired her restaurant back, Houston said, but to this day, she continues to encounter other people in similar situations.
"As a small business owner in Kansas, I have two or three people a month that contact me and ask me if I will employ them under the table," she said. "Because they’re on Medicaid, and they can’t make more money than what they make. But they want to work. They want to make more money. They want to do something with themselves. And you are holding those people back by not expanding Medicaid, because they can’t make more than $9,000, or they lose their insurance."
The bill would expand Medicaid eligibility in Kansas to include anyone in households with incomes below 138 percent of the federal poverty level, or $35,218 a year for a family of three.
According to the most recent estimates, the cost to the state for providing care to those newly-eligible individuals would be about $100 million a year. But advocates said much of that cost would be offset through savings from things like higher prescription drug rebates.
The bill also is slightly different from the one debated in 2017 because it includes a provision that most able-bodied adults who enroll in Medicaid work at least 20 hours a week or enroll in a workforce training program.
But Kansas Department of Health and Environment Acting Secretary Jeff Andersen said the Colyer administration remains opposed to expanding Medicaid.
"One consistent theme that we have heard from our stakeholders is that we should not make major changes to the Medicaid program until we get a better handle on the operational challenges that we face," he told the committee.
He said the administration does support some enhancements to the existing Medicaid program, including expanding access to mental health care and substance abuse treatment and increasing the use of telemedicine.
He also said the agency does not necessarily accept the cost estimates that were given to lawmakers because other states that have expanded Medicaid have seen their enrollments grow much faster than their initial estimates.
Other opponents of the bill included representatives from conservative think tanks, including the Kansas Policy Institute, whose spokesman James Franko said extending Medicaid coverage to people currently uninsured would not necessarily improve their health outcomes.
"A card of insurance, Medicaid in this case, does not necessarily guarantee access to care," he said.
Later in the meeting, though, that comment drew a sharp rebuke from Sen. Barbara Bollier, R-Mission Hills, who is a retired physician.
"It's very difficult to hear people who have health insurance stand up here and say that it doesn't make any difference," she said. "And I am ashamed in this position that anyone would say that."
Committee chairwoman Sen. Vicki Schmidt, R-Topeka, wouldn't predict whether the bill would make it to the floor of the Senate or, if it does, whether it would be brought to a vote by the full Senate before the so-called "turnaround" deadline of Thursday, Feb. 22, for most bills to pass out of their chamber of origin.
"I have to have bills out by Monday (Feb. 19)," she said after the meeting, referring to the deadline for most committees to send their bills to the full chamber. "We have several bills that we're going to try to work on Monday. This is certainly on the list if anyone wants to move the bill forward."