A deal to clear the way for Medicaid expansion next year that some Kansas lawmakers thought they had brokered in the waning hours of their just-finished legislative session appears to be unraveling.
Instead, the conservative leaders and moderate rank-and-file Republicans find themselves splitting in an intra-party fight.
Rep. Don Hineman led a last-minute insurrection by moderate House Republicans in the final days of this spring’s legislative session. They joined Democrats in demanding a Senate vote on Democratic Gov. Laura Kelly’s expansion bill and held up passage of the state budget to force that roll call.
Then, on the session’s final night, Hineman told reporters that his forces had reached an agreement with Senate leaders.
“We have achieved some assurances that have moved the ball in the right direction,” Hineman said.
The handshake deal, he said, committed the Senate to voting on a compromise expansion bill at the outset of the 2020 session. Importantly, he said, Senate leaders also agreed to leave the writing of the bill to a bipartisan committee of House and Senate members rather than a “handful” of conservative senators.
A week later, differing accounts of that agreement now undermine trust and the chances that lawmakers will start the 2020 session with anything approaching consensus on how to expand Medicaid coverage to tens of thousands more low-income Kansans.
Senate Majority Leader Jim Denning, an Overland Park Republican, said Hineman’s account is “fairly accurate” with one big exception: Senate leaders didn’t agree to let a joint study committee — with legislators from both the House and Senate, Republican and Democrat — write the compromise bill.
Instead, he said, a Senate committee headed by Sen. Gene Sullentrop, a Wichita Republican and expansion opponent, will take the lead.
Notably, the House had passed an expansion bill. In the Senate, Denning and Senate President Susan Wagle refused to bring that bill to the floor for a vote.
“The House doesn’t set the Senate agenda,” Denning said in a recent interview with the Kansas News Service.
Denning said he was “very clear with Representative” Hineman about how he planned to proceed.
“No,” Hineman said when reached for a response, he wasn’t.
“That is certainly not my interpretation of the discussion we had,” Hineman said. “That’s very discouraging.”
Rep. John Eplee, an Atchison Republican who also participated in the negotiations, confirmed Hineman’s account that Senate leaders, including Denning, agreed to allow a joint committee to write the bill.
“That’s what he promised us in the meeting,” Eplee said, adding that Denning also pledged to use the governor’s bill as a starting point.
Believing they had won all the concessions they were going to get, Eplee said moderate Republicans dropped their demand for an immediate Senate vote.
“That helped turn the fire down,” he said.
But it ignited House Democrats’ frustration. Rep. Tim Hodge, a Democrat from Newton, said the coalition would have prevailed if moderate Republicans had continued to block passage of the budget.
“We all stayed and a bunch of you strayed,” Hodge said on the session’s final night. “We could have done this.”
The governor was also frustrated. Kelly anchored her campaign on expansion and thought she could get it done in her first session.
But, she said, moderate Republicans should have known better than to trust Denning, who for years had been one of the Legislature’s most outspoken opponents of expansion.
“The fact that he’s now reneging now on what some thought was a promise is not shocking at all,” Kelly said.
Kelly’s expansion bill passed the House 69-54 in March. A majority of senators also supported the bill, but Wagle and Denning wouldn't allow it to come to a vote despite intense pressure from advocates who accused Republican leaders of denying life-saving care to thousands of vulnerable Kansans.
“I don’t run on emotion,” Denning said. “I understand the need to look at Medicaid expansion. I plan on doing it.”
Denning said he makes no apologies for tackling other priorities first, such as paying off state pension fund obligations and resuming construction on suspended highway projects before committing to expanding an already “very big entitlement program.”
“Once you turn that program on, there’s no turning it off,” he said. “That’s why I think it needs to have a lot of good due diligence.”
Hineman and other legislative supporters of expansion are concerned that the Senate bill will include a work requirement and host of other provisions favored by conservatives but opposed by Democrats and the interest groups pushing the issue, including the Kansas Hospital Association.
“That means we’re back in the middle of a probably very contentious wrangle over what the final product should be,” he said.
Wagle seemed to confirm those concerns at a late session news conference when she said any expansion plan that clears the Senate "will be very different" than the one that passed the House this year.
Medicaid Expansion in Brief:
- Kelly’s expansion plan would extend coverage under KanCare — the state’s privatized Medicaid program — to an estimated 130,000 more low-income Kansans.
- A Medicaid expansion bill similar to the one introduced by Kelly and passed by the House was approved by the 2017 Legislature. It was vetoed by then Republican Gov. Sam Brownback and the Legislature narrowly failed to override his veto.
- Expansion would cover Kansans making up to 138 percent of the federal poverty level. That’s $17,236 for an individual or $35,535 for a family of four.
- Currently, the Kansas Medicaid program provides health coverage for children, pregnant women, individuals with physical and cognitive disabilities and elderly Kansans who have exhausted their resources. Adults with children are eligible, but only if they make less than 38 percent of the federal poverty level —- $9,538 for a family of four. Adults without children aren’t eligible for coverage no matter their income.
- States and the federal government jointly fund Medicaid. Kansas’ share of those costs is approximately $1.3 billion annually. If Kansas expands its program, the federal government would cover 90 percent of the additional costs. The state’s share would be between $34 million and $42 million per year.
- Expansion would generate an additional $913 million in federal Medicaid funding for Kansas, according to the Kansas Hospital Association. Supporters claim an associated boost in state tax receipts would help cover the cost of expansion.
- Thirty-seven states and the District of Columbia have adopted Medicaid expansion. Kansas and Missouri are among 14 that haven’t.
- The federal government has approved waivers for Medicaid work requirements in nine states, though federal court decisions have blocked implementation in some of them.
This story originally listed an incorrect figure for the amount of additional money that Medicaid expansion would draw from the federal government.
Jim McLean is the senior correspondent for the Kansas News Service, a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio covering health, education and politics. You can reach him on Twitter @jmcleanks.
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