Kansas Gov. Sam Brownback may be willing to institute Medicaid expansion in a state facing a $350 million budget shortfall, but a bill in the legislature faces tough deadlines and major hurdles just to reach a vote.
Brownback, a Republican, suggested last week that he might expand Medicaid to more low-income adults if the state can find a way to cover any costs not covered by the federal government, according to the Lawrence Journal-World. That statement, delivered to a group of insurance agents, came months after campaigning forcefully against President Barack Obama’s signature health law in a competitive re-election fight.
"I’ve been pushing that anything we do on Medicaid expansion has to be 100-percent paid for," he said.
A bill that’s up for two days of hearings next week would authorize the governor to negotiate a “budget-neutral” expansion with the Centers for Medicare and Medicaid Services, but the bill’s sponsor -- a Republican -- calls it a “tall order” to get the bill to a vote.
There are several reasons for that. For one, the last day of hearings coincides with the legislature’s cutoff date to move legislation out of committees and to the floor. Another Republican supporter of Medicaid expansion, who has a more detailed bill, said parliamentary rules prevent the committee from immediately taking up the bill for a vote for at least a day.
Bringing a bill that hasn’t received approval in committee to the floor of the state House for final approval is possible, but it would take a supermajority of lawmakers, said Rep. Don Hill, who's sponsoring the bill up for a hearing next week. Republicans outnumber Democrats by more than three to one in both the House and the Senate, which would also have to take up any bill the House passed.
“We’re taking baby steps," Hill said. "We are making progress. We’ll keep all options open as far as what is in the realm of the possible, recognizing that it may not be probable.”
To do so, Hill would have to persuade fellow Republicans like Rep. Daniel Hawkins, who heads the health committee and remains opposed to expansion. Aiding Hill is the state hospital association, which commissioned a study that found extending coverage to 250,000 low-income people would produce net savings by increasing tax revenue, lowering uncompensated care and freeing up state money from existing programs serving the poor. The federal government covers 100 percent of expansion through 2016 and at least 90 percent thereafter, though many conservatives doubt it can maintain that matching rate.
“From this study, it does appear if we expand [Medicaid] in Kansas it will pay for itself, so there won’t be the necessity of talking about offsetting revenues,” said Cindy Samuelson, the communications and fundraising chief for the Kansas Hospital Association. “But if the state wants to talk about that, we do want to make sure there are a lot of options that can be talked about.”
Those options include increasing tobacco taxes and hiking fees for the private organizations that run Medicaid through state contracts. But Rep. Tom Sloan, a Republican who sponsored a more detailed Medicaid bill, argues supporters need to provide some more assurance to reluctant lawmakers, and he’ll make that case during the upcoming hearings. His bill pushes a more conservative line on Medicaid expansion through requirements such as premiums for patients, but would also set up an assessment system to tax hospitals and other medical providers at varying levels up to a certain cap. It would also study ways to capture revenue from employers benefiting from the influx of federal money to make new hires.
“It will not go anywhere without a revenue source to start with,” Sloan said. "The governor can say, ‘Thank you, but I can’t do anything.’”
Hill said he’s open to Sloan’s ideas, but just getting the bill to the floor is still his top concern. It’s also clear Sloan’s pitch to provide guaranteed funding doesn't reassure everyone. Hawkins, the health committee chairman, said he not only doubts the program will be a net positive because enrollment will outpace estimates, but he doubts any financial arrangement with medical groups can keep the state off the hook.
“How much can they pay?” he asked. “Let’s say this thing costs $300 million a year and they say, ‘Well, that might be kind of tough. We’ll pay $100 million.’ The state is left holding the bag.”
In a caucus with a lot of conservatives, Hawkins said he’s not the only one who doesn’t think the time will ever be right for Medicaid expansion in Kansas.