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After Years of Wrangling, Kansas Leaders Reach Deal to Expand Medicaid Expanding Medicaid Was a Pipe Dream in Kansas. Now It May Become Reality.
(about 20 hours later)
Kansas’ Democratic governor said on Thursday that she had reached a deal with Republicans who control the Legislature to expand Medicaid under the Affordable Care Act. If lawmakers approve the plan in the coming weeks, it would end years of wrangling over the issue in a state that has endured a series of rural hospital closures.Kansas’ Democratic governor said on Thursday that she had reached a deal with Republicans who control the Legislature to expand Medicaid under the Affordable Care Act. If lawmakers approve the plan in the coming weeks, it would end years of wrangling over the issue in a state that has endured a series of rural hospital closures.
“It’s a lot easier to get to no than it is to get to yes, but this is what governing looks like,” said Jim Denning, the Republican leader in the Kansas Senate, who negotiated the agreement with Gov. Laura Kelly, a Democrat who took office last year after eight years of Republicans controlling state government.“It’s a lot easier to get to no than it is to get to yes, but this is what governing looks like,” said Jim Denning, the Republican leader in the Kansas Senate, who negotiated the agreement with Gov. Laura Kelly, a Democrat who took office last year after eight years of Republicans controlling state government.
The deal in Kansas came despite longstanding Republican divisions about whether to expand Medicaid, and reflected the impact of Ms. Kelly’s election in 2018. Though Ms. Kelly’s agreement included provisions to help Medicaid recipients find jobs, it stopped short of a work requirement that some Republicans in Kansas and other states have long called for.The deal in Kansas came despite longstanding Republican divisions about whether to expand Medicaid, and reflected the impact of Ms. Kelly’s election in 2018. Though Ms. Kelly’s agreement included provisions to help Medicaid recipients find jobs, it stopped short of a work requirement that some Republicans in Kansas and other states have long called for.
When a state expands Medicaid, many more low-income adults become eligible for largely free health insurance provided by the government. In many states that have not expanded the program, very few adults qualify unless they are pregnant or have disabilities.When a state expands Medicaid, many more low-income adults become eligible for largely free health insurance provided by the government. In many states that have not expanded the program, very few adults qualify unless they are pregnant or have disabilities.
Republicans in some states have voted against expansion because of financial concerns and because of opposition to the Affordable Care Act.Republicans in some states have voted against expansion because of financial concerns and because of opposition to the Affordable Care Act.
The agreement in Kansas, which would become the 37th state to expand Medicaid, came amid signs of new momentum for expansion in several conservative-leaning holdout states. Republican leaders in Wyoming have talked recently about seriously considering expansion, and in Oklahoma, supporters pushed to place a proposal to expand Medicaid on the 2020 ballot. Supporters in Missouri and Florida are trying the same strategy, although in Florida, the measure would require a constitutional amendment that Republican lawmakers are trying to quash.The agreement in Kansas, which would become the 37th state to expand Medicaid, came amid signs of new momentum for expansion in several conservative-leaning holdout states. Republican leaders in Wyoming have talked recently about seriously considering expansion, and in Oklahoma, supporters pushed to place a proposal to expand Medicaid on the 2020 ballot. Supporters in Missouri and Florida are trying the same strategy, although in Florida, the measure would require a constitutional amendment that Republican lawmakers are trying to quash.
But the Affordable Care Act, under which the federal government shoulders most of the cost of expanding Medicaid, faces legal threats. Expanded Medicaid could end abruptly if a lawsuit seeking to invalidate the law succeeds.But the Affordable Care Act, under which the federal government shoulders most of the cost of expanding Medicaid, faces legal threats. Expanded Medicaid could end abruptly if a lawsuit seeking to invalidate the law succeeds.
In Kansas, members of both parties said they were hopeful the deal announced on Thursday would gain legislative approval and be signed into law. But the state has come close to expanding Medicaid before. In 2017, the Republican-dominated Kansas Legislature approved expansion. The measure was vetoed by Sam Brownback, the Republican governor at the time, and lawmakers were unable to override him.In Kansas, members of both parties said they were hopeful the deal announced on Thursday would gain legislative approval and be signed into law. But the state has come close to expanding Medicaid before. In 2017, the Republican-dominated Kansas Legislature approved expansion. The measure was vetoed by Sam Brownback, the Republican governor at the time, and lawmakers were unable to override him.
“We’re not here to declare victory,” Ms. Kelly said on Thursday while announcing the deal. “We’ve got a long way to go in this process. We really need to think of this as more like a halftime pep talk.”“We’re not here to declare victory,” Ms. Kelly said on Thursday while announcing the deal. “We’ve got a long way to go in this process. We really need to think of this as more like a halftime pep talk.”
Mr. Denning, the Republican senator, said enough lawmakers to pass the bill in his chamber had signed on as co-sponsors.Mr. Denning, the Republican senator, said enough lawmakers to pass the bill in his chamber had signed on as co-sponsors.
The Kansas House passed a version of Medicaid expansion last year. But State Representative Stephanie Clayton, a Democrat from Overland Park, said it remained something of an open question how the measure would fare this year in her chamber, which is controlled by Republicans.The Kansas House passed a version of Medicaid expansion last year. But State Representative Stephanie Clayton, a Democrat from Overland Park, said it remained something of an open question how the measure would fare this year in her chamber, which is controlled by Republicans.
“I am optimistic, but I’m also aware of the fact that we have a lot of heavy lifting ahead of us,” said Ms. Clayton, who supports expansion.“I am optimistic, but I’m also aware of the fact that we have a lot of heavy lifting ahead of us,” said Ms. Clayton, who supports expansion.
The expansion debate in Kansas has been shaped by a wave of hospital closures in rural parts of the state. In some cases, that has forged unlikely alliances between rural Republicans and urban Democrats.The expansion debate in Kansas has been shaped by a wave of hospital closures in rural parts of the state. In some cases, that has forged unlikely alliances between rural Republicans and urban Democrats.
Without expanded Medicaid, some rural hospitals have struggled with higher rates of uninsured patients and lower rates of repayment. One hospital that closed in Independence, Kan., in 2015 would have received an estimated $1.6 million a year if Medicaid had been expanded. Since then, three more rural hospitals have closed in the state.Without expanded Medicaid, some rural hospitals have struggled with higher rates of uninsured patients and lower rates of repayment. One hospital that closed in Independence, Kan., in 2015 would have received an estimated $1.6 million a year if Medicaid had been expanded. Since then, three more rural hospitals have closed in the state.
Despite the unfinished steps, supporters of Medicaid expansion said they were hopeful the measure would pass this year.Despite the unfinished steps, supporters of Medicaid expansion said they were hopeful the measure would pass this year.
“This agreement is clearly the most significant progress we have seen in the Medicaid expansion debate in Kansas,” Tom Bell, the president of the Kansas Hospital Association, said in a statement. “It represents real compromise and is undoubtedly the best, and maybe the only, way to get this through the Legislature.”“This agreement is clearly the most significant progress we have seen in the Medicaid expansion debate in Kansas,” Tom Bell, the president of the Kansas Hospital Association, said in a statement. “It represents real compromise and is undoubtedly the best, and maybe the only, way to get this through the Legislature.”