Amy Houston got the bad news — a diagnosis of Hodgkin Lymphoma — in 2009.
She started working 10-hour days in her corporate job to get Fridays off for chemotherapy. But that schedule no longer worked when the time came for daily radiation treatments.
“I lost my job and therefore lost my medical insurance,” Houston said.
Saddled with mounting debts, Houston, tried to sell a pizzeria she owns in the small town of Mulvane to raise cash, but the deal fell through.
As if life wasn’t hard enough, in 2013 Houston’s cancer returned.
Uninsured and out of money, Houston, a single mother of four, said she decided to skip further treatment until she could afford it. She and her children were left obsessing about her symptoms and how they might be signaling the progression of the disease.
“It’s a constant reminder to them that they might not have me for much longer,” she said.
An estimated 150,000 Kansans are in similar circumstances: too poor to afford health insurance but still not eligible for Medicaid.
Supporters of expanding Medicaid eligibility in the state, some notable Republicans among them, will point to cases like Houston’s in this year’s effort to offer Medicaid to a wider swath of the state’s working poor.
She’ll testify Wednesday at a Senate Public Health and Welfare Committee hearing on a bill to expand eligibility for KanCare, Kansas’ privatized Medicaid program.
“I want them to see a face of a person that lives in this state by choice, that has this struggle and chose to do the best I can to do things right,” said Houston, now 37. “[The lawmakers are] my solution.”
Last month, Houston purchased insurance in the Obamacare marketplace. But she fears the coverage is only temporary because she’ll have to earn $20,000 more than she expects to this year to qualify for the federal subsidy that makes the plan affordable.
Currently, KanCare eligibility is limited to children, pregnant women, people with disabilities and seniors in need of long-term care who have exhausted their financial resources. Parents are eligible only if they earn less than a third of the federal poverty level, less than $10,000 for a four-person family.
Single adults without children currently are not eligible no matter their income. Expansion would extend eligibility to all Kansans who earn up to 138 percent of the poverty level, or about $17,000 annually for an individual and approximately $34,000 for a family of four.
Kansas lawmakers passed an expansion bill last session. But then-Gov. Sam Brownback vetoed the effort and lawmakers fell a few votes short when they tried to override him.
Brownback’s recent departure for a job in the Trump administration and the installation of former Lt. Gov. Jeff Colyer as governor give expansion advocates some optimism.
“My hope is that he stays true to his word that he’s going to listen to the people of Kansas,” said Republican Sen. Barbara Bollier, a retired physician from Mission Hills and a strong supporter of expansion.
Multiple polls in recent years have shown large majorities of Kansas voters support expansion.
Still, Colyer continues to oppose it, frequently saying, as he did last weekend in Manhattan, that Kansans “are not interested in expanding Obamacare.”
Groups of expansion supporters showed up at meet-and-greets scheduled by Colyer in Manhattan and Atchison to lobby the new governor. Videos posted to Facebook show Colyer initially debating the issue before giving up and attempting to leave at least one event earlier than scheduled. Undeterred, several in the crowd followed him out the door.
“Expand Medicaid or lose your job,” one man shouted as Colyer’s SUV pulled away.
He said Tuesday that the lobbying effort hasn’t changed his longstanding opposition to expansion.
“No,” Colyer said. “Look, Washington is going to be changing the rules and the president’s budget even showed the elimination of that [expansion]. We need a Kansas solution, not Obamacare.”
The budget proposal released this week by President Donald Trump once again calls for the repeal of the Affordable Care Act and Medicaid expansion. But after failing to repeal the health insurance law last year, some Republican congressional leaders, particularly in the Senate, don’t appear eager reprise that fight.
“One of the key reasons those [repeal] efforts failed is that Republican governors lobbied to keep Medicaid expansion in their states,” said Sheldon Weisgrau, a spokesperson for the Alliance for a Healthy Kansas, a foundation-supported group lobbying for expansion. “Congress is not going to be able to easily repeal the ACA.”
Even so, some Kansas legislative leaders say now isn’t the time to pass an expansion bill. For starters, there isn't the money. With lawmakers potentially needing to put hundreds of millions of additional dollars into public education, they say the state couldn't afford its share of expansion costs even with the federal government footing 90 percent of the bill.
“We have no way of paying for expanded Medicaid,” said Senate Majority Jim Denning, an Overland Park Republican.
Weisgrau and other advocates — most notably the Kansas Hospital Association — argue that the billions of additional federal dollars that would flow into the state would more than cover the cost of expansion. Weisgrau points to recent studies that document the “positive impact” of expansion in other states, including thousands of new jobs.
“There’s no reason to think that Kansas would be any different,” he said.
In addition, Weisgrau said, studies show that the risk of rural hospitals closing is higher in states that didn’t expand Medicaid under Obamacare.
So far, 33 states and the District of Columbia have expanded eligibility for their Medicaid programs. Kansas and Missouri are among the 18 states that haven’t.
Jim McLean is managing director of the Kansas News Service, a collaboration of KMUW, Kansas Public Radio and KCUR covering health, education and politics in Kansas. Follow him on Twitter @jmcleanks.