If the Affordable Care Act remains the law of the land, Kansas policyholders will have an important decision to make that would affect more than 150,000 Kansans.

That would be whether to expand the Medicaid program, which is the federal- and state-funded program that provides health care in Kansas to low-income families, children and people with disabilities.

The ACA required that states expand their Medicaid programs to include all non-elderly persons with incomes up to 133 percent of the federal poverty level, or about $30,000 annually for a family of four, or risk losing all federal Medicaid funding. That eligibility expansion would have had a significant impact in Kansas because currently only adults who earn less than 27 percent of the federal poverty level — $6,035 for a family of four — are eligible for Medicaid, and childless adults don’t qualify at all unless they are elderly or have a disability.

While the U.S. Supreme Court upheld most of the ACA, it struck down the Medicaid requirement, making expansion of the program optional.

“That raises a lot of questions for states,” Suzanne Schrandt, of the Kansas Health Institute, said at a recent forum on the court’s ruling.

Schrandt said that of the state’s 350,000 uninsured people, 151,000 would qualify for the expanded Medicaid if Kansas enacts the changes.

Of those 151,000 who would qualify, 130,000 are low-income adults who currently do not qualify for Medicaid in Kansas, she said.

Gov. Sam Brownback is an ardent opponent of President Barack Obama’s health care law and has said he hopes presumptive Republican presidential nominee Mitt Romney wins election in November and tries to repeal the law.

“Stopping Obamacare is now in the hands of the American people. It begins with a new president this fall,” Brownback said.

Attorney General Derek Schmidt said he was disappointed in the Supreme Court upholding the ACA but said the court’s ruling on Medicaid was a win for states. Kansas was one of 26 states that challenged the law and the proposed expansion of Medicaid was part of that challenge.

Referring to the court, Schmidt said, “It also rejected the federal government’s effort to transform the Medicaid program from a federal-state partnership into a centralized program run by Washington, from Washington and solely for Washington. These legal rulings will benefit the long-term vigor of our federal system.”

But Jay Angoff, the regional director of the U.S. Department of Health and Human Services, said when “cooler heads prevail,” states will expand Medicaid. Under the ACA, the federal government will pay the entire cost of newly eligible Medicaid population for three years. The federal contribution decreases to 90 percent by 2020 with the states picking up the remaining costs. The Obama administration has said 17 million people nationwide will be covered by the Medicaid expansion.

“The states will see what a good deal this is,” Angoff said.