Medicaid Expansion Dies in Kansas, But Legislature Could Bring It Back to Life

by | March 30, 2017

By Bryan Lowry

Gov. Sam Brownback vetoed legislation that would have expanded Medicaid to cover 150,000 low-income Kansans, setting up another showdown between the Republican governor and a state legislature that shifted toward the political center in the last election.

Brownback's veto, which was announced Thursday morning on Twitter, had been highly anticipated and comes amid speculation that he will take a job in President Donald Trump's administration. The Kansas Legislature has 30 days to override Brownback's veto, which would require two-thirds majorities in both the House and Senate.

The Legislature's vote to expand Medicaid under the Affordable Care Act, also known as Obamacare, received national attention both because Kansas is a solidly Republican-leaning state and because the state Senate's vote took place shortly after congressional Republicans abandoned a plan that would have repealed the ACA and blocked states from expanding Medicaid after March 1.

"I am vetoing this expansion of ObamaCare because it fails to serve the truly vulnerable before the able-bodied, lacks work requirements to help able-bodied Kansans escape poverty, and burdens the state budget with unrestrainable entitlement costs," Brownback said in his veto message.

I vetoed Medicaid expansion. It does not prioritize the vulnerable. It does not #DefundPP. It isn't responsible. It's bad for Kansas. #ksleg pic.twitter.com/ydoooJK4fV

-- Sam Brownback (@govsambrownback) March 30, 2017

Medicaid, which relies on a combination of federal and state funds, provides health coverage to disabled people and low-income families. The ACA enabled states to expand the program to provide coverage to people who would make too much money to qualify for the program under previous rules but also make too little to buy insurance through the federal health care exchange.

Sean Gatewood, spokesman for the KanCare Advocates Network, a group that represents disabled Medicaid beneficiaries, said that Brownback needs to stop using the disability community as an excuse to oppose Medicaid expansion.

"He needs to check the record. The disability community's 100 percent behind this," Gatewood said. "People are caught in that gap who have disabilities. They just don't necessarily meet the Social Security guidelines. He's completely off base."

Former Kansas Gov. Kathleen Sebelius, a Democrat who oversaw the rollout of the ACA as secretary of health and human services for the Obama administration, said Wednesday that her home state had "a lot to gain and very little to lose by allowing people to access the health benefits that they're entitled to." Sebelius said that expansion is particularly important for states like Kansas with a large number of farm families that may not be able to obtain insurance through their employers.

"Suffice it to say, if this bill had come to my desk, I would have loved it," Sebelius said the day before Brownback's veto was announced.

Amy Falk, CEO of Health Partnership Clinic, a safety net clinic network with locations in Johnson County, said that many of the people using her clinics work part-time jobs and are not eligible for benefits through their employer. Others don't work but could if their health needs were addressed.

"We see time and time again, individuals who have chronic health conditions that, if they were managed, could be working, productive members of our community," she said. "When you're diabetic and your sugars aren't right, you're not going to work."

Brownback also targeted Planned Parenthood in his veto message. The women's health care provider receives Medicaid reimbursement for birth control, cancer screenings and other services but not abortions.

"Most grievously, this legislation funnels more taxpayer dollars to Planned Parenthood and the abortion industry. From its infancy, the state of Kansas has affirmed the dignity and equality of each human life. I will not support this legislation that continues to fund organizations that undermine a culture of life," Brownback said.

Brownback had previously criticized lawmakers for voting down an amendment that would have prohibited Medicaid funds from going to Planned Parenthood.

Laura McQuade, the president and CEO of Planned Parenthood Great Plains, said in a phone call that Brownback's mention of the organization was a political ploy meant to deter members of his own party from voting for an override.

"We refuse to be the pawn in his game to suppress the well-being of so many Kansans who need Medicaid expansion today in order to live the lives that they're meant to live and that he has promised them," McQuade said.

Rep. Susan Concannon, a Beloit Republican who has pushed for expansion for several years, rejected Brownback's effort to tie the issue to abortion.

"It's not an abortion bill despite some comments that I heard this morning," she said. "That was out of left field. You talk about moving targets, there's a new one for us."

The Kansas House kicked off a debate on overriding the veto shortly after Brownback's announcement, but tabled the debate after an hour. That effectively pauses the issue until a lawmaker moves to restart the debate.

Unless some lawmakers change their votes, expansion supporters are three votes shy of the two-thirds majority needed to override the governor's veto in the House and two votes shy in the Senate. Earlier in the session, Brownback vetoed a bill that would have rolled back his signature tax policies. An override passed in the House, but fell short in the Senate.

Finding the additional votes will be difficult, but health care advocates are hoping they can use the weekend to sway lawmakers with a flurry of constituent phone calls and emails.

Rep. Sean Tarwater, a Stilwell Republican who previously voted against expansion, said it was time to move on from expansion and that he did not plan to change his vote.

House Majority Leader Don Hineman, a Dighton Republican, said he still felt there was a sentiment in both chambers to find a way to make Medicaid expansion happen.

"In the end it comes back to protecting those who are in that gap and cannot afford coverage," Hineman said. "There's a benefit, not only to them directly, but to the state to have them covered and have them on a path to better health."

Brownback has vetoed 13 bills during his tenure as governor, but has only been overridden once.

Kansas has missed out on nearly $1.8 billion in federal aid since 2014 by not expanding Medicaid, according to the Kansas Hospital Association. Expansion was fully funded by the federal government through 2016 and will gradually fall to 90 percent by 2020. The Kansas bill included a provision that would enable Kansas to undo expansion if federal funding dipped below the 90 percent threshold.

The closure of a hospital in Independence, Kan., in 2015 was largely blamed on the state's failure to expand the program. Concannon pointed to this Thursday.

"If this isn't the right time, when is the right time?" Concannon said. "Are we going to wait for some more hospitals to close? Are we going to wait until we have people die that can't get insurance?"

Americans For Prosperity, which has ties to Wichita-based Koch Industries and has helped lead opposition to Obamacare on a national level, applauded Brownback's veto, contending that expansion would have cost more than anticipated.

"Looking at neighboring states, there is proof expanding Medicaid will only increase pressure on Kansas taxpayers to fund a program that will undoubtedly go over budget," said Jeff Glendening, the state director for AFP, in a statement. "I hope legislators understand the gravity of this program and do not vote to override this veto. AFP will hold them accountable."

Rep. John Whitmer, a Wichita Republican, appeared to echo this point as the House debated whether to override the governor, reading off a list of states that he said went over budget after expanding Medicaid.

"We've got budget problems," Whitmer said. "We just have to keep that in mind."

Brownback signed a bill in 2014 requiring legislative approval before the state could expand Medicaid. The Legislature passed the expansion bill Tuesday with a bipartisan majority. Supporters pointed to the 2014 law and accused Brownback of hypocrisy for ignoring the Legislature's will three years later.

House Minority Leader Jim Ward, a Wichita Democrat, said he was "incredibly disappointed" at the quick veto.

"They're just cowards," Ward said. "They're doing it today in this expedited fashion so they don't have to hear from the people of Kansas. They know they're going to get emails and calls.

"Why do you think the governor expedited his veto? He didn't want to hear from people who say 'Don't veto the bill.' So he not only broke his word that it was a legislative decision, he did it in a way that the people of Kansas couldn't weigh in."

The Star's Andy Marso contributed to this report.

(c)2017 The Kansas City Star (Kansas City, Mo.)