Medicaid expansion is Laura Kelly's top priority. Can her sixth try pass the Legislature?

For the sixth time, Gov. Laura Kelly will propose that the Legislature expand Medicaid in Kansas — and history suggests she is likely to fail for the sixth year in a row.

Outside William Newton Hospital in Winfield, Kelly announced Wednesday that Medicaid expansion is her No. 1 priority for the 2024 legislative session.

"Expanding Medicaid and ensuring that every Kansan has access to affordable, high-quality health care is the smartest, sanest way to keep our state moving forward," Kelly said.

"When the legislature reconvenes in January, I will propose Medicaid expansion for the sixth time so Kansas can achieve a healthier workforce and a healthier economy. I encourage every Kansan to call their legislator and tell them to demand that legislative leadership give them a chance to vote for Medicaid expansion."

Kelly said she'll be traveling across the state this fall to promote Medicaid expansion with a "Health Workers, Healthy Economy" tour.

Republican leadership is unlikely to be persuaded.

"The Governor's Welfare Express Tour will derail the state budget," said Senate President Ty Masterson, R-Andover, and House Speaker Dan Hawkins, R-Wichita, in a joint statement. "Big government is not and will never be the answer to increasing health care access to Kansans."

Medicaid expansion has popular support

An estimated 72% of Kansans support Medicaid expansion, according to last fall's Kansas Speaks statewide public opinion survey from Fort Hays State University. Meanwhile, 10% of respondents opposed Medicaid expansion while 18% were neutral.

"Trust me when I tell you that there are many Republican legislators who are just as frustrated as I am that we have failed to get this done," Kelly said.

Masterson and Hawkins dispute the popular support.

"When explained correctly, this is something Kansans are overwhelmingly against," they said.

Kansas leaders disagree on whether Medicaid expansion has benefits

Much of the argument for Medicaid expansion centers on closing the coverage gap, where people earn too much to qualify for Medicaid but too little to be eligible for subsidies that can make buying health insurance more affordable.

The governor said Census data show nearly 140,000 Kansans have a job but don't have health insurance. Meanwhile, expanding Medicaid would create an estimated 23,000 new jobs.

Masterson and Hawkins don't want those able-bodied adults to get taxpayer funded health insurance. They want to focus efforts on eliminating Medicaid waiting lists "to ensure the truly needy get the services they so desperately need."

"Medicaid expansion extends services to able-bodied adults who either choose not to work or are already eligible for a free or reduced private healthcare plan and expansion passes that additional cost burden directly onto the backs of Kansas taxpayers who are already strapped due to inflation," Masterson and Hawkins said.

Kelly said Medicaid expansion will lower health care costs for everyone, while not expanding Medicaid means more costs to taxpayers. The fiscal note on her plan from last year estimated $71.5 million in savings to the state general fund in the first fiscal year.

Medicaid expansion would also save private-sector employers money on health care costs, she said. A past Kansas Health Institute study put the savings on health premiums and tax penalties at between $40 million and $80 million per year.

"Our refusal to expand Medicaid is not saving us money," Kelly said. "We are giving up the opportunity to bring tax dollars back to our state."

The federal government would foot 90% of expansion costs with the rest falling on the state. Opponents point to the added cost to state taxpayers of Medicaid expansion — with some suggested it would be "budget busting" — while supporters point to the $6.5 billion so far in federal money the state has missed out on.

Kelly pointed to six hospital closures and reports on the risk of additional closures due to financial pressures. She said health care professionals are leaving the state for better-paying jobs in neighboring states that have expanded Medicaid.

Masterson and Hawkins contend that Kelly's plan does not solve problems in the health care system. They said hospitals have closed in states that have expanded Medicaid.

"We have learned from other states," they said, "that expanding Medicaid does not solve the problems it promises but actually creates more in the form of unsustainable increases in costs to taxpayers and more government dependency when we desperately need more, not less people in the workforce."

Kelly argued that when other states have expanded Medicaid, "the states make that back by saving money on other services, bringing in more workers, and boosting the economy."

Governor urges Kansans to call their legislators

Kelly said she has tried to address the concerns of House and Senate leadership with custom-tailored legislation, but "they are not serious about solving the challenges around health care in our state."

It does not appear that any custom tailoring would get the top two Republicans on board.

Hawkins said Medicaid expansion "is a red line for me."

"We're really not talking about negotiating on what that looks like," Masterson said after a Thursday tax event. "I honestly feel that's just political; they feel there's a political advantage."

Kelly told reporters on Thursday that she hopes a Medicaid expansion deal could be made with Republican leadership.

"I'm hoping so," Kelly said. "We've done it before."

She referenced a bipartisan compromise she made in 2020 with then Senate Majority Leader Jim Denning, R-Overland Park. But even with the support of one high-ranking Republican, the bill never got a vote as leadership tied it to anti-abortion politics before the pandemic shutdown.

"Unfortunately, the legislative leadership would not let it come up for a vote, so it went nowhere," Kelly said. "But I know that there are a bipartisan group of legislators there who, if given the opportunity to vote for Medicaid expansion, I'm absolutely certain it would pass."

She urged people to call their legislator to tell them to "demand that Legislative leadership give them a chance to vote for Medicaid expansion."

Republicans followed leadership in past votes on Medicaid expansion

But when Democrats have attempted procedural moves to force the Legislature to vote on Medicaid expansion, Republican rank-and-file have followed leadership.

Such was the case in March when Rep. Heather Meyer, D-Overland Park, tried to amend a food stamp work requirement bill into a Medicaid expansion bill. The move ultimately failed, but it did force every Republican in attendance, plus one Democrat, to go on record as effectively voting against Medicaid expansion.

Hawkins had predicted the vote earlier in the day during a GOP caucus.

"This bill is as germane to Medicaid expansion as you can get," he said. "It has Medicaid expansion written all over it, so expect today a vigorous debate on Medicaid expansion. Whenever this bill comes up, everybody needs to be in there. We don't want to get caught and not have everyone.

"They're going to bring an amendment, there's going to be vigorous debate, we just need to vote it down and move along. So get ready."

Meyer's amendment did indeed spark vigorous debate — until the rules committee deemed it not germane, and the chamber voted to sustain the ruling.

Jason Alatidd is a statehouse reporter for the Topeka Capital-Journal. He can be reached by email at jalatidd@gannett.com. Follow him on Twitter @Jason_Alatidd.

This article originally appeared on Topeka Capital-Journal: Laura Kelly is unlikely to get Medicaid expansion in Kansas in 2024