In March, the state House voted to make more low-income people eligible for government-run health insurance, as allowed under the federal Affordable Care Act. Anthony Hensley, the Democratic leader in the Senate, forced a procedural vote that could have moved the House bill onto the Senate floor.
The move needed support from 24 of the 40 senators to succeed. It fell just short, garnering 23 votes.
“It is very clear that a strong majority in the Kansas Senate support Medicaid expansion and want the opportunity to debate and vote on it this year,” Democratic Gov. Laura Kelly said after the vote.
Thirty-six states have expanded Medicaid coverage and eligibility. Two years ago, the Kansas Legislature voted in favor of expansion but failed to override a veto by Sam Brownback, then the GOP governor.
Since passage of the Affordable Care Act in 2010, support for Medicaid expansion has grown, but the idea is still opposed by many Republican lawmakers. Other Democratic governors, including Tony Evers of Wisconsin and Roy Cooper of North Carolina, have tried and failed to make headway on the issue this year.
Republican leaders in the Kansas Senate maintain that the state can’t afford to take on the costs of expanding Medicaid, despite the promise from Washington that the federal government will pick up 90 percent of the tab.
Support from U.S. Sen. Bernie Sanders, a presidential candidate, may have hurt Medicaid expansion's chances in Kansas. After Sanders tweeted his approval of the House vote, Republican opponents in Kansas characterized the idea as a “socialist” one.
“Socialist Bernie Sanders and his allies lost today, but Kansans won,” tweeted Dan Hawkins, the House majority leader.
In Kansas, polls indicate that a solid majority of residents support expansion. During her campaign last year, Kelly made clear that Medicaid expansion would be one of her top priorities as governor.
“I’m voting yes for the rural hospitals that desperately need health and my constituents who need a lifeline,” Republican Ed Berger said on the Senate floor.
Expansion Supporters Flocked to Capitol
Supporters of Medicaid expansion -- lobbyists, citizens and members of the state House -- packed the Senate chamber for Wednesday's vote.“So many people are out there it’s ridiculous,” one Senate aide muttered.
Those who were refused entry monitored the action from just outside the chamber, listening in via YouTube.
“I worked with a lot of families in poverty,” said Scott Henson, a retired educator who came to the capitol to watch the vote. “I know what challenges families have, and I know Medicaid expansion would support those families who don’t currently qualify.”
Along with other supporters, Henson was frustrated that the proposal didn’t receive a straight up-or-down vote.
In a meeting last week with the governor, Senate GOP leaders argued that the idea needs more study, saying they would work in the coming months on a bill to consider during next year’s session. Senate Majority Leader Jim Denning pointed out that the current bill -- which was passed by the House as an amendment -- had received no hearings or testimony. He also argued it wasn’t “prudent” to take on additional costs before the state Supreme Court has ruled whether a recently passed budget will be enough to satisfy the court’s demand for increased education spending.
“I vote ‘pass’ because I’m not saying no. I’m saying this policy isn’t ready,” Denning said.
The Case For and Against Expansion
Supporters point out that expanded Medicaid has been in place in most states for nearly a decade, and that studies from expansion states indicate that the influx of federal health dollars has generated sufficient economic activity to offset additional coverage costs borne by the states themselves.Gov. Kelly estimates that Kansas has sent $3 billion to Washington in support of Medicaid expansion but seen no benefit.
“It’s so sad that we pay so much money into the Medicaid system and don’t get the coverage,” says Anita Austin, who works for a social justice advocacy group in Topeka and was monitoring the Senate action.
But Republicans worry the feds may pull the rug out from under them. They argue the state would face a heavy burden if Washington stops funding the expansion, as has happened with other government programs.
Conservative opponents also point to a study examining Medicaid expansion in Oregon that showed that while beneficiaries reported improvements in mental health and relief from financial anxiety, markers of physical health did not improve. Advocates maintain that sustained access to health care provides clear benefits over time. The Oregon study only looked at care over a two-year timeframe.
How a Bill Becomes a Law (or Not)
In Kansas, the issue didn't receive a full floor debate. The process itself, however, became a matter for debate.GOP Sen. Molly Baumgardner complained that bills that are moved to the floor without consideration in committee are the “worst type of legislation we can pass.” But Democratic Sen. Barbara Bollier said it was “abhorrent” that the Senate wasn’t allowed to consider the underlying bill.
Republican Carolyn McGinn said she was unhappy about the process, which has not allowed an airing of all the issues involved. But she said she'd heard from many constituents who support expansion and decided to support the procedural maneuver.
“As much as I hate this process, it’s the only path we’ve been given,” McGinn said. “As chair, if I had a bill 24 members wanted, I’d let them have it.”
A Political Price to Pay?
The bill is likely dead for the year. Senate President Susan Wagle is adamant that Medicaid expansion won’t receive floor time this session, which will end in about two weeks.Denning, the majority leader, has become a particular target of Medicaid advocates. They placed placards around the capitol grounds featuring his picture and asking, “Why won’t Senator Jim Denning Expand KanCare?”, the name of the state’s Medicaid program.
Democrats hope that putting senators' opposition to Medicaid expansion on the record could cost them some voters' support in next year’s elections. Denning’s district supported Kelly along with three of the four other Democrats who ran for statewide office last year. Democratic state Rep. Cindy Holsher announced last week that she will challenge Denning, due to his opposition to Medicaid.
“Sen. Denning once again refused to support Med Expansion today,” Holsher tweeted. “If you r disappointed w/his vote, this would be a good time to contribute to my campaign.”
But Republicans aren’t convinced they’ll pay a political price.
“Politically, I don’t think Medicaid expansion is going to be a big winner,” says Alan Cobb, president of the Kansas Chamber of Commerce, which opposes expansion. “It’s become a Democratic and liberal litmus test, and I don’t think that’s going to play well in a state like Kansas.”
