Medicaid Expansion Is Still ‘Not in Kansas’

Published March 2, 2016

Sniping among Republicans escalated tensions in Kansas’ Medicaid expansion deliberations and prompted state Senate President Susan Wagle (R-Wichita) to promise a full debate in the coming weeks on whether to expand KanCare, the state’s Medicaid program.

The “KanCare Bridge to Prosperity Program” legislation, Senate Bill 371, was introduced January 27. The bill’s House counterpart, House Bill 2633, titled the KanCare Bridge to a Healthy Kansas Program, was introduced on February 8. Each bill would extend Medicaid eligibility to individuals whose income is 133 percent of the federal poverty level.

The state’s House leadership has continually blocked votes on expanding Medicaid, and the state Senate leadership and Gov. Sam Brownback (R) have voiced their opposition to expansion.

Mixed Messages

“But so that there can be no question of where the Kansas Senate stands on this issue, the body will take up the question of KanCare expansion under Obamacare for a vote in the next few weeks,” Wagle said in a February 13 press release. “Once that vote is taken, I think it will be clear that a majority of the Kansas Senate firmly oppose expansion of KanCare under Obamacare.”

Wagle’s release was one of several she issued regarding her removal of state Sen. Mary Pilcher-Cook (R-Shawnee) from her chairmanship of the Senate Public Health and Welfare Committee. Wagle said Pilcher-Cook, who opposes Medicaid expansion, violated Senate rules by trying to add an “anti-Obamacare amendment” to an unrelated bill.

Pilcher-Cook told Health Care News she had challenged the Senate Rules Committee’s ruling that her amendment was out of order, but she was outvoted 15–22. Pilcher-Cook says the point of her action was to send a message to the Kansas House.

“Because I was aware the majority of the Kansas Senate was opposed to expanding Medicaid, I offered the amendment as a way to communicate with the Kansas House,” Pilcher-Cook said. “It was my way of saying, ‘The Senate opposes Medicaid expansion. There is no need for the Kansas House to spend time or energy on the subject.'”

Pilcher-Cook says she doubts Wagle’s commitment to opposing Medicaid.

“Ever since Obamacare passed, President Wagle has made numerous public comments that she is open to the idea of expanding Medicaid in the State of Kansas,” said Pilcher-Cook.

In a statement to the press, Wagle said she “firmly oppose[s] Obamacare.”

Wagle’s office did not respond when specifically asked whether Wagle opposes expanding KanCare.

Expansion Still an Option?

Wagle’s phrasing in her press release echoes Brownback’s State of the State Address: “It was Obamacare that caused the problem. We should not expand Obamacare to solve the problem.”

An October 2015 memo from Brownback’s deputy communications director, Melika Willoughby, called expanding Medicaid “morally reprehensible.” But when asked what Brownback would do if a bill to expand the program reached his desk, Brownback spokesperson Eileen Hawley left the door open.

“We do not speculate on any pending legislation,” Hawley told Health Care News. “However, the governor will carefully review any bill that comes to his desk.

“The governor has consistently said that any Medicaid expansion effort would need to be fiscally sustainable, include a work requirement for able-bodied adults with no dependents, and eliminate the waiting list for individuals with disabilities,” Hawley said.

Expansion ‘Not the Answer’

Kansas Policy Institute Vice President and Policy Director James Franko says expanding Medicaid would not solve Kansas’ health insurance shortfalls or increase access to affordable, quality health care.

“Expanding Medicaid is not the answer to real concerns about health insurance and access to quality care,” Franko said. “Expanding Medicaid would bust the Kansas budget and not improve health outcomes, as we saw via the recent study in Oregon,” referring to a 2014 study published by the American Association for the Advancement of Science.

“The feds have already admitted they cannot sustain the Medicaid match, so the budget impact will only grow in the future,” Franko said.

Others oppose Medicaid expansion because it would encourage able-bodied Kansans to depend on the government while making access to care more difficult for disabled individuals.

“Expanding Medicaid would increase the cost of health care for a majority of Kansas citizens, and it would harm the quality of health care for all Kansas citizens,” Pilcher-Cook said. “It would create dependencies on government by able-bodied, childless adults, and it would put able-bodied adults in the front of the line while thousands of Kansans with intellectual disabilities are still sitting on waiting lists for needed services.”

Brownback spokesperson Hawley cited placing the able-bodied ahead of the disabled as a reason for opposing expansion.

“Expansion of Medicaid creates new entitlements for able-bodied adults without dependents, prioritizing those who choose not to work above those who are intellectually, developmentally, or physically disabled,” Hawley said.

Pressing for Alternatives

Hawley says Lt. Governor Jeff Colyer, who is a medical doctor, is spearheading a search for alternative policies to improve delivery of health care services in rural areas of the state.

Franko agrees with that approach, saying Kansas should expand telemedicine and direct primary care, a system in which physicians and patients agree upon a monthly fee for a suite of services, bypassing insurance companies, instead of expanding Medicaid.

“In a rural state like Kansas, expanded telemedicine and direct primary care offer tremendous potential to increase access and quality care,” Franko said. “Loosening scope-of-practice restrictions also brings more providers into a position to help serve the needs of patients. At the same time, these sorts of changes increase access, [and] they don’t ask Kansas taxpayers for more money to expand Medicaid to able-bodied, childless adults.”

Pilcher-Cook says legislation that would serve Kansans better than expanding KanCare is already in the works, such as a bill to encourage charity care.

“We are also working on a pilot project that would provide health care cost transparency to state employees,” Pilcher-Cook said.

Dustin Siggins ([email protected]) writes from Washington, DC. Michael Hamilton ([email protected]) is The Heartland Institute’s research fellow for health care issues and managing editor of Health Care News.

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