By Appealing To Both Sides, A Kansas Medicaid Expansion Plan Risks Opposition From All Directions
TOPEKA, Kansas — A top Republican in the Kansas Senate said he’s designed a Medicaid expansion plan that aims to walk a fine line — one that can win over conservatives without losing support from moderate Republicans and Democrats.
But the proposal also risks satisfying neither faction.
Republican Senate Majority Leader Jim Denning outlined a proposal this week that would grow the Medicaid health care plan to cover an added 150,000 or so low-income Kansans.
His strategy includes a mix of policies inspired by ideas from Republicans and Democrats. But the plan also adds in the private insurance market, with the goal of stabilizing the federal health care exchange in Kansas where people without Medicaid buy private coverage.
The would-be bill passed an initial hurdle Wednesday. A special Senate committee recommended the plan get further study during the coming legislative session that kicks off in January.
Denning said the ultimate goal is securing health care coverage for as many Kansans as possible.
“There’s things to like about it on both sides of the fence,” Denning said.
It comes after years of wrangling over the issue. Supporters have failed to overcome opposition from leadership in the past. Coming into this session, some Republican leaders said they’re going to work on the topic.
To try to attract Democrats and moderate Republicans, the bill would expand health coverage. But it doesn’t take the simple path Democrats have pushed for of expanding Medicaid to cover people with incomes up to 138 percent of the federal poverty level.
Many of the new people covered would go into the regular Medicaid health care program. But the bill would also use private insurance for some low-income Kansans.
It would leverage $50 million in tobacco and vaping taxes to make plans sold through the federal health care exchange — established through the Affordable Care Act, or Obamacare — more generous and affordable. That’s intended to draw more people to that market.
Doing that could help stabilize costs on the health care exchange, Denning hopes.
“The exchange is in a death spiral,” Denning said, “and if we can leave those patients there and bring in new patients, we can probably save it.”
The blueprint would also require some people to pay 5 percent of their household income in premiums. If they fall too far behind, they’d be locked out of Medicaid coverage for six months.
Some conservative lawmakers want work requirements to be part of any expansion plan. Denning’s bill doesn’t include strict work rules, but people working fewer than 20 hours per week would be referred to a state program aimed at connecting them to jobs.
“Let’s find out why they’re not working and see if we can get them working,” Denning said.
That’s a good compromise to Republican Sen. Molly Baumgardner, who likes that it can inform unemployed people about services they might not know exist.
Baumgardner doesn’t support strict work requirements because she’s concerned it might create problems for people like single mothers, who may have to leave children in unsafe conditions or in unlicensed child care to meet a work requirement.
“What we see far too often is when a single mom is trying to work and care for children, that’s when the problems occur,” Baumgardner said.
Other Republicans would like a requirement insisting that at least some of the people getting health care through Medicaid get employment.
“If you don’t have children and you have an able body, I’d like to see effort for work,” Republican Sen. Ty Masterson said.
Masterson said the lack of stronger works rules and concerns over the cost mean he’s not backing the bill.
Expanding Medicaid would cost over $1 billion per year. Federal taxpayers would cover 90 percent of that, state money would pay for the rest. New fees on health care providers would help cover the cost under Denning’s plan.
The bill faces opposition from some Democrats. Adding private insurance into the plan adds additional complications, and Senate Minority Leader Anthony Hensley said that will lead to delays if the federal government doesn’t approve it.
Hensley wants to vote on a bill that simply expands Medicaid without adding other issues like private insurance.
“That ought to be the first step,” Hensley said. “That ought to be the only step that this Legislature passes this session.”
Denning’s bill includes a fail-safe. If the federal government doesn’t approve the private insurance proposals, the bill directs the state to submit a Medicaid plan without them.
Democratic Gov. Laura Kelly urged lawmakers last month not to over-complicate Medicaid expansion. She didn’t give Denning’s plan a warm reception.
“We don’t need to create extra bureaucratic red tape, raise taxes, and create more hurdles to access to health care,” Kelly said in a statement.
Advocates for Medicaid expansion are still digesting all the details in Denning’s proposal, but they’re feeling upbeat that lawmakers who previously opposed expansion are now bringing forward ideas.
“It looks like this is a good-faith effort,” said April Holman, executive director of the group Alliance for a Healthy Kansas. “We’re encouraged that we’re seeing this conversation happen.”
Stephen Koranda is Statehouse reporter for Kansas Public Radio and the Kansas News Service, a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio covering health, education and politics. Follow him on Twitter @kprkoranda or email skoranda (at) ku (dot) edu.
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