The effort stalled at the eleventh hour when pro-expansion Republicans in the Senate backed off by not agreeing with Democrats to a procedural vote that would have moved the bill this calendar year. The motion was one vote short, with Senate Majority Leader Jim Denning choosing to “pass.” “I’m not saying no,” Denning told the reporters, “I’m saying this policy isn’t ready.”
Medicaid expansion seemed to be a strong possibility this year with support of Gov. Laura Kelly, a Democrat, and her party controlling the State House. Lawmakers threatened to uphold passage of the state’s budget to get action on expansion but then a wing in the Senate fought back with a plan to reduce the size of the budget.
After legislation stalled, Denning (R-Olathe) told reporters, “it is not a question of if, but rather when and how.”
In its 2012 ruling upholding most of the Affordable Care Act (ACA), the U.S. Supreme Court allowed states to opt out of the law’s expansion of Medicaid, leaving each state to decide whether to participate. Some states have opted for expansion, others have not, and some, like Kansas, are still debating the issue.
“None of us have any idea how this is going to move forward at this point, but this is one of the governor’s and the majority of the legislature’s … both of their priorities,” Sen. Barbara Bollier, a Mission Hill Democrat and supporter of Medicaid expansion, told the Wichita Eagleon March 24.
For Senate Republicans, the stumbling block is the enormous cost of the program, which they say they fear will wreak havoc with the state’s budget. There is also concern that once Kansas applies for expansion, it will be up to the federal government to determine the details of the program.
“You don’t come back and fix it next year,” Senate Majority Leader Jim Denning said. “She’s [Gov. Kelly] going to have to tell me where she’s heading.”
Free Money Is Not Free
According to the Kansas Health Institute, expanded Medicaid would cost the state $520.8 over 10 years. Of particular worry is the federal government’s long-term commitment to cover 90 percent of the cost, with the state picking up the remaining 10 percent. Already over $22 trillion in debt, the federal government could decide to scale back its share, leaving Kansas and other states on the hook for the rest.
Kansas House Democrats were able to use parliamentary maneuvers to ease passage in the lower chamber, but in the Senate, Republicans have the power to keep almost any bill from coming up for a vote. At press time, Medicaid expansion backers in the Senate were reportedly three votes shy of what is needed to force debate on the issue.
Lennie Jarratt, a state government relations manager at The Heartland Institute, which publishes Health Care News,believes a Medicaid expansion bill will ultimately be halted in the Senate.
“I don’t believe it will have the votes to pass the full Senate,” he said. “Despite the claims of its supporters, Medicaid expansion is not ‘free money’ from Washington. It will cost Kansas millions.”
Bonner R. Cohen, Ph.D., ([email protected]) is a senior fellow at the National Center for Public Policy Research and a senior policy analyst with the Committee for a Constructive Tomorrow (CFACT).