Lawmakers in Republican-led Kansas vote to expand Medicaid

TOPEKA, Kan. -- Kansas' Republican-controlled Legislature approved an expansion Tuesday of state health coverage to thousands of poor adults under former president Barack Obama's health care overhaul, days after the collapse of GOP leaders' repeal effort in Washington.

The bill would expand the state's Medicaid program for the poor, disabled and elderly so it would cover up to 180,000 additional adults who aren't disabled. It now heads to conservative Republican Gov. Sam Brownback.

The collapse of efforts by President Donald Trump and top Republicans in the U.S. House to repeal the 2010 Affordable Care Act buoyed supporters of expanding Medicaid in Kansas.

But the move's success in the GOP-leaning state also reflected elections last year that brought more moderates and liberals into the Legislature.

"I'm ecstatic! I am, and I'm high on happiness," said state Sen. Barbara Bollier, a moderate Kansas City-area Republican and retired anesthesiologist. "The citizens of this state took a stand in November and said we wanted change, and now you're seeing it."

But lawmakers on both sides of the debate expect Brownback to veto the measure. He long has been a critic of Obama's health-care law and endorsed a plan pursued by Trump and GOP congressional leaders.

The term-limited governor declared in January expanding Medicaid under the law would be "airlifting onto the Titanic," though he hasn't said whether he would veto this bill.

The failure of Republicans in Washington to quickly repeal Obama's health-care law has led to speculation more states will consider Medicaid expansion. Democratic governors are pursuing expansions in North Carolina and Virginia; an initiative is on the ballot in November in Maine.

U.S. House Speaker Paul Ryan said Tuesday he will give its Republicans another chance at passing a health care overhaul but did not offer a timeline.

"I don't think it makes any sense to jump on expanding Medicaid when the rules could change significantly," said Kansas Senate Majority Leader Jim Denning, a Kansas City-area Republican.

The bill would not have passed the Kansas Legislature last year. At least eight new state senators replaced Republicans who likely would have opposed expanding Medicaid. In the House, the same could be said for at least 20 members.

But the 25-14 vote Tuesday in the Senate was two votes shy of the two-thirds majority necessary to override a veto. The House approved the bill last month on an 81-44 vote , three votes short of a two-thirds majority.

Obama's Affordable Care Act encouraged states to increase the number of people eligible for Medicaid by promising to pay most of the costs. Thirty-one states, including some led by GOP governors, have expanded Medicaid.

Kansas critics argued expanding Medicaid still would be too expensive for the state, which is facing projected budget shortfalls of more than $1 billion through June 2019 after massive personal income tax cuts championed by Brownback.

Kansas' Medicaid program covers about 377,000 poor, disabled and elderly residents, but poor adults younger than 65 who aren't disabled and don't have children aren't eligible. Brownback's administration projected the extra costs of expanding the program at $66 million total for the state's 2018 and 2019 budgets.

"There's no question in my mind that this would be a huge cost to the state," said Shawn Sullivan, the governor's budget director.

But the Kansas Hospital Association projects a net gain for the state, arguing in part an influx of federal dollars would ripple through the state's economy. Hospitals were a crucial part of the lobbying for the bill; supporters believe the expansion would prevent some hospitals from shuttering.

"What I saw were people who couldn't afford insurance using emergency rooms, not getting adequate care," said freshman Republican state Sen. Ed Berger, who led his hospital's board. "Those hospitals were having to absorb a lot of that."