Kansas lawmakers fail in last-ditch effort to pass Medicaid expansion ahead of elections

Kansas lawmakers who support Medicaid expansion on Friday failed in a last-ditch effort to pass the measure, setting the stage for Democrats to campaign on the issue this fall.

The Kansas Senate voted 18-17 on a motion to place Medicaid expansion legislation on the floor. Under Senate rules, 24 votes were needed.

The failure, while not entirely unexpected, forced senators to take a procedural vote related to expansion in an election year where Democrats are seeking to break the Republican supermajority in the Legislature.

Republican leaders have largely resisted expansion over the past decade, leaving Kansas as one just 10 states without it. Upwards of 150,000 additional Kansans would be eligible for health coverage under expansion, with the federal government picking up 90% of costs and offering millions in incentives.

Democratic Gov. Laura Kelly, who has made expansion a signature priority during her two terms, entered the 2024 legislative session taking a more confrontational approach with Republicans over the issue. After past efforts at compromise failed, Kelly and Democrats instead opted for a more openly political approach to pressure GOP leaders.

Sen. Pat Pettey, a Kansas City, Kansas, Democrat, emphasized how the Legislature hadn’t advanced expansion for over half a decade. Lawmakers have passed expansion just once, in 2017, but the measure was vetoed by Republican Gov. Sam Brownback.

“I would hate to see Kansas be the last state in the union to make this wise decision to pass Medicaid expansion. But it seems to be that we’re on that road instead of looking forward for the good of the health of Kansans,” Pettey said on the Senate floor.

Lawmakers held hearings on Medicaid expansion for the first time in four years in March. But GOP leaders haven’t brought up expansion for debate in either the House or Senate.

Republican opponents offer a variety of reasons for their position. They have said expansion would benefit “able-bodied adults” who could be working and have said the state should be focusing on providing services for residents with intellectual and physical disabilities who have to endure a lengthy waitlist for help. Expansion advocates have rejected that stance as a false choice.

Sen. Caryn Tyson, a Parker Republican, said she supports a “Kansas solution.” Friday’s vote was procedural, she said, and not on Medicaid expansion itself. And, she said, Medicaid has been expanding by increasing the availability of services to individuals on the waitlist.

“Those are people in need, not able-bodied Kansans who choose not to have insurance,” Tyson said.

Sen. Beverly Gossage, a Eudora Republican who chairs the Senate Public Health and Welfare Committee, in opposing the motion said extensive hearings were held on expansion. “We had discussions on this floor,” she added.

Polling indicates most Kansans support Medicaid. A recent poll from the Sunflower Foundation found that 68% of Kansans including 51% of Republican primary voters support expansion.

Democrats plan to emphasize expansion in races against Republicans this fall. Every legislative seat will be on the ballot, and a number of competitive races – including in Democratic-leaning Johnson County – may determine whether Republicans maintain their veto-proof majorities in both the House and the Senate.

“We’re gonna pick up some more seats in the House on this issue,” House Minority Leader Vic Miller, a Topeka Democrat, said.

Senate Minority Leader Dinah Sykes, a Lenexa Democrat, said Kansans would remember the votes of Republicans opposed to expansion.

“They’ll remember how they voted against the nearly 80% of Kansans who support Medicaid expansion. They’ll remember in November,” Sykes said.

Seeking to overcome Republican objections, Kelly’s expansion plan this year included work requirements – an idea long favored by conservatives. It says able-bodied adults must provide documentation showing they’ve been employed for the past 12 months, including a pay stub and tax papers.

There were several exceptions including for: caregivers, veterans, full-time college students, individuals experiencing homelessness, people with a permanent disability or who are mentally or physically unfit for employment, residents who volunteer at nonprofits for 20 hours a week, parents of children under the age of 18, and others.

Applicants would have had to provide proof of employment or community engagement at the time of entry and renewal each year, Kelly previously said the “work requirement will make sure that no one is taking advantage of the program without doing their part.”

In a December interview with The Star, Kelly said she hoped the concessions would bring more Republicans to the table. But she also telegraphed the more political posture taken this year.

“It’s always been my typical, bring people to the table, talk about it, negotiate, collaborate,” Kelly said.

“None of that worked, obviously. So we’ve just taken on a more political approach to it. It’s been nothing but a political issue. There is no good policy, no good budgetary reason not to expand Medicaid, it’s purely political.”

The Star’s Katie Bernard contributed reporting