Brownback softens stance on Medicaid expansion

? Gov. Sam Brownback suggested Wednesday that he might consider proposals to expand Medicaid under the Affordable Care Act, provided the Legislature can identify a way to pay for it.

“I’ve been pushing that anything we do on Medicaid expansion has to be 100-percent paid for,” Brownback said during impromptu remarks to the Kansas Association of Insurance Agents, who met at the Statehouse on Wednesday.

Under the federal health law, also known as Obamacare, states are allowed to expand their Medicaid programs to cover all individuals in households with incomes up to 138 percent of the poverty level. That’s about $16,243 a year for an individual, or $27,724 for a family of three.

During the first three years, the federal government pays 100 percent of the cost of covering those who become newly eligible under the expansion. That tapers down to 90 percent of the cost by 2020.

For the traditional group covered by Medicaid, the federal government pays only about 56 percent of the cost, while the state picks up the other 44 percent.

Kansas is currently one of only 14 states that has not adopted a plan to expand its Medicaid program.

Brownback’s comments, which came in response to a question from one of the insurance agents, stood in stark contrast to his remarks on the campaign trail last year when he said he strongly opposed the federal health care law, also known as Obamacare, and criticized his Democratic opponent Paul Davis for supporting it.

“I haven’t said we’ll take it. I haven’t said we wouldn’t,” Brownback said Wednesday. “Last year, I signed the bill that the Legislature passed (saying) that the Legislature had to approve any Medicaid expansion. I think that’s the way to go because it’s going to involve long-term costs. And the Legislature, that’s their primary authority.”

His softened tone also came amid mounting pressure at the Statehouse from hospitals and other health care providers who want Kansas to take part in the expansion because it would mean additional reimbursements for them, offsetting losses they suffer from providing uncompensated care, as well as reduced reimbursements from Medicare, the federal health insurance program for the elderly.

They also came as the Kansas House, responding to some of that same pressure, is preparing to hold hearings on at least two Medicaid expansion bills, including one being pushed by Rep. Tom Sloan, R-Lawrence, who chairs the House Vision 2020 Committee.

During his remarks, Brownback alluded to Sloan’s bill, which would levy a fee on health care providers who receive Medicaid reimbursements. Those fees would be used to cover the state’s 10 percent share of the cost.

But Brownback repeated a concern he has expressed many times about the federal government’s ability to pay its 90 percent share in years to come.

“It would not be inconceivable whatsoever that when you’re going to tweak the budget on Medicaid to say ‘No, we’re going to change it to what we do on all of Medicaid,'” Brownback said. “The extended price tag jumps dramatically.”

Brownback’s Press Secretary Eileen Hawley said the governor’s comments don’t represent a dramatic shift in his opinion about Medicaid expansion.

“The Governor wants to fully understand the fiscal impact to the state budget, including the potential impact if the federal government is unable to maintain the 90% match due to their fiscal challenges,” Hawley said in an email. “He also continues to believe we should focus on providing services for the disabled Kansans who are currently on waiting lists and already eligible for Medicaid services before expanding eligibility to able-bodied Kansans.”