Kansas Fiscal Woes Forcing Brownback To Consider Medicaid Expansion

Gov. Sam Brownback (R) and the Republican-controlled legislature in Kansas is inching ever so slowly toward expanding Medicaid under Obamacare. If Kansas did expand Medicaid, it would be the latest in a list of deep-red states—including Arkansas, Utah, and Indiana—to actually take federal dollars through Obamacare, despite having conservative legislatures and fire-breathing, anti-ACA Republican governors.

The chances of Brownback, who is facing an enormous budget deficit, signing into law a bill expanding Medicaid in the state is still far from a sure thing, but it became slightly more likely during some legislative maneuvering last week. Conservative legislators were forced to agree to hold a hearing on expanding Medicaid in exchange for getting state Rep. Jim Ward (D) to drop an amendment to a bill that would have simply expanded Medicaid in the state to 138 percent of the poverty line.

Brownback, who had previously expressed strong opposition to Obamacare, signaled Wednesday he wasn’t totally opposed to a Medicaid expansion.

“I haven’t said we’ll take it. I haven’t said we wouldn’t,” Brownback said according the Lawrence Journal-World. “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.”

Now, the conservative Kansas state legislature will hold a hearing on a proposal being crafted by the Kansas Hospital Association in talks with Brownback’s staff that would expand Medicaid in the state through Obamacare. It’s an odd situation given that Brownback, a conservative governor who’s gotten plenty of national attention for standing by his unusually deep tax cuts, has previously opposed expanding Medicaid through Obamacare.

The specific plan that’s been in the works between the Kansas Hospital Association and Brownback’s staff is meant to be acceptable to a Republican governor like Brownback, according to Ward, the Democratic state representative. It’s similar to other plans used in Republican-controlled states to expand Medicaid through the Affordable Care Act.

The plan, according to Kansas’s KCUR, would use federal Medicaid funds to let adults with low incomes buy private insurance coverage. Most important, though, is that the proposal strikes a law passed by conservative Republicans that bars the governor of Kansas from expanding Medicaid without first getting legislative approval.

“What the Hospital bill does is strike that law, repeal that,” Ward told TPM on Tuesday. “And then it directs the governor to engage CMS [Centers for Medicare & Medicaid Service] and get a waiver to expand Medicaid on the red-state model, which is vouchers to buy insurance through the exchanges, it has a work training requirement, and it also has some copay, similar to Arkansas and Indiana.”

Local coverage of the legislative developments has warned that expansion is still not a sure thing, but there have been three recent indicators suggesting that there’s still a possibility. One is that House Speaker Ray Merrick (R) has promised to hold hearings on expanding Medicaid soon, although a date hasn’t been set. Merrick declined an interview but released a statement to TPM saying he had concerns.

“The Health Committee is going to hold hearings. We have been waiting on answers for questions surrounding the long-term viability of sustaining expansion when the ACA remains under such scrutiny,” Merrick said in the statement. “Additionally, there have not been answers to questions about expanding the Medicaid program when people who are currently eligible are still on waiting lists for services for intellectual and physical disabilities.”

Another is that the Medicaid bills made it through the “turnaround” deadline in the state that is an important marker for whether a bill is going anywhere or not.

“I know the Hospital Association has been approaching his people and saying ‘what is the best chance to convince the governor, what would it have to look like?'” Ward told TPM.

Kansas Hospital Association spokeswoman Cindy Samuelson said that Brownback’s staff has been talking with her organization for a while now.

“For a long time we’ve been talking about what a Kansas solution might look like, what are options of the plan, what are some guiding principles to look looking at,” Samuelson said. “So we have been talking with the governor’s staff and folks from [Kansas Department of Health & Environment] and lots of policy makers from around the state about this for quite a while.”

Why are conservative Republicans even allowing talk of Medicaid expansion to happen? Kansas’s ongoing fiscal woes. Washburn University political science professor Mark Peterson noted that “it’s quite a chunk that would come to the state through Medicaid if we had gotten on board with the program.”

“Given that the state is not enjoying a robust economic recovery from the recession and that the state coffers are as depleted as they are, a lot of people…are considering swallowing any cavils they may have about dealing with federal programs and federal oversight and embracing the idea that ‘look, it’s money, it’s like a nest on the ground,'” Peterson said.

Peterson cautioned that even given that idea, expanding Medicaid “is still going to be a tussle.”

Still, there seems to be some hope. The Lawrence Journal-World noted that during discussion of Ward’s amendment on expanding Medicaid, conservative state Rep. Scott Schwab (R) stood up and stressed that while he did not oppose expanding Medicaid, he opposed that particular amendment.

“I’m not one of the people who are absolutely opposed to expanding Medicaid,” Schwab said. “As a matter of fact, I would have rather expanded Medicaid as opposed to doing the ACA altogether.”

In the end, Peterson wagers, whether there is Medicaid expansion or not depends on how tempted Republican lawmakers are to take the federal money.

“It’s going to be ‘okay, we gotta have the money. So let’s find the votes and get this thing done,'” Peterson said of what lawmakers would need to be thinking for an expansion to happen. “And if they don’t have that kind of pressure, then I don’t think it will happen.”