House Speaker Ray Merrick reversed course Thursday and finally agreed to allow committee hearings on the subject of expanding Medicaid under the Affordable Care Act.

Only days earlier, Merrick reportedly had told Reps. Tom Sloan of Lawrence and Barbara Bollier of Mission Hills, both moderate Republicans, that he would not allow such hearings. Sloan chairs the Vision 2020 committee that advanced a Medicaid expansion bill earlier in the session. Bollier, a retired physician, also serves on that committee.

But Merrick was forced to change his mind Thursday when Rep. Jim Ward, D-Wichita, offered an expansion proposal as an amendment onto a minor bill that would authorize the Kansas Medicaid program to pay reimbursements for donated breast milk as a medical treatment for infants.

Because Ward’s amendment also dealt with Medicaid, it was considered relevant to the underlying bill, and that could have forced a vote on an issue that GOP leaders weren’t fully prepared for. But Ward agreed to withdraw his amendment in exchange for a personal assurance by the speaker that Medicaid expansion would get a hearing.

One of the factors that helped swing the decision, according to Sloan and Bollier, was fresh memory of the previous day’s vote on a bill dealing with teacher contract negotiations. Conservatives had brought up a bill that would have taken away the exclusive bargaining rights of teachers unions and given every teacher authority to negotiate contracts individually.

But moderates offered up a substitute bill reflecting a negotiated compromise between the state’s largest teachers union and associations representing school boards, superintendents and administrators. The amendment passed on Wednesday, 67-52, and the final bill was approved and sent to the Senate Thursday with 109 yes votes.

“It’s the first vote where you could ascertain the ideological bent of the body,” Sloan said, referring to the teacher negotiations bill. “That doesn’t mean that there are 67 firm votes on everything, but it was a wake-up call.”

Bollier said the impact of that vote may extend even further.

“To me it was a definite sign that constitutional changes are going to be incredibly difficult, if at all possible,” she said.

Bollier was referring to proposed constitutional amendments that did not reach the floor of the House this week that would change the way Kansas Supreme Court justices are selected.

Constitutional amendments require a two-thirds majority vote in both chambers, followed by a simple majority of voters in a public election.

Another indicator that Medicaid expansion may still have hope in the House came when Rep. Scott Schwab, a conservative Republican from Olathe, stood up to speak on Ward’s Medicaid amendment. Schwab said he opposed the amendment, not because he opposed expanding Medicaid, but because he didn’t like the method that Ward was calling for.

“I’m not one of the people who are absolutely opposed to expanding Medicaid,” Schwab said. “As a matter of fact, I would have rather expanded Medicaid as opposed to doing the ACA altogether. … If we just said, ‘How many people would like to expand Medicaid and help those who need increased access to care but are lacking the resources to get typical day-to-day insurance,’ a lot of us would say yes, we want those folks to get access to care. But it’s hard to get 63 people (the minimum majority vote in the House) to agree on how to do that.”

Ward’s amendment would have repealed a law passed last year that requires legislative approval to expand Medicaid under the Affordable Care Act and prohibits the governor from acting on his own. The amendment would have authorized Gov. Sam Brownback to enter negotiations with the U.S. Department of Health and Human Services on a plan for how to implement Medicaid expansion in Kansas.

Sloan pointed out, though, that Ward’s proposal did not provide any funding for an expansion. Under federal law, the state would eventually be required to pay 10 percent of the cost of covering those who would become eligible under the expansion.

The bill that the Vision 2020 committee endorsed would levy a fee on health care providers that receive Medicaid reimbursements to cover the state’s 10 percent share. In exchange, those providers would receive the remaining 90 percent of funding that would come from the federal government.