Kansas will hold first hearings on Medicaid expansion in years; plan unlikely to advance

Dozens of advocates are expected to arrive at the Kansas Statehouse Wednesday for their first opportunity in four years to testify on Medicaid expansion.

The proposal, long a top priority of Democratic Gov. Laura Kelly, has been dead on arrival in the state Legislature for years. It was last seriously considered when Kelly struck a deal with then Senate Majority Leader Jim Denning in 2020. But the bill did not make it through the process and GOP leaders have been vehemently opposed ever since.

Medicaid expansion, which was made available in the Affordable Care Act, is estimated to extend coverage to more than 150,000 Kansans. The state is one of 10 in the nation that has not yet expanded coverage. The federal government has made millions in incentive dollars available to hold out states that expand.

Advocates argued in hearings Wednesday morning that coverage could hold broad benefits for state residents, hospitals and jails.

Advocates of expansion see the scheduling of public hearings in the House and Senate as a major win in a year when other red states, including Mississippi are contemplating moving forward on expansion.

“Having the opportunity to hear from both sides of this issue will make a huge difference,” said April Holman, executive director of Alliance for a Healthy Kansas, a pro-expansion advocacy group.

But the hearings are unlikely to lead to meaningful advances on the proposal this year. Legislators are set to leave Topeka in just over two weeks. And top lawmakers including House and Senate leadership and the chairs of the health committees in both chambers remain opposed.

GOP leaders cite a variety of reasons to oppose Medicaid expansion. They argue the expansion would add “able-bodied adults” who could otherwise be working to the Medicaid rolls and make it harder for those already in the system to access care.

Sam Adolphsen, with the conservative think tank the Opportunity Solutions Project, said during the hearing Wednesday that expand Medicaid have seen their costs rise beyond expectations.

And over the years Republicans have raised concerns that the federal government may not uphold its end of the bargain on expansion.

House Minority leader Vic Miller, a Topeka Democrat, says most of those arguments fail when subject to scrutiny and based on the experience of other states.

Instead, he points to the personal biases of House Speaker Dan Hawkins, a Wichita Republican who works in insurance sales.

“What else has he got,” Miller said. “The arguments against this fail.”

Hawkins sells group insurance. The two health chairs Rep. Brenda Landwehr of Wichita and Sen. Beverly Gossage of Eudora have also worked in insurance though Landwehr is no longer licensed. All three say their personal work and income would not be impacted by expansion.

Hawkins and Landwehr said that, despite arguments made over the years, their personal experience in insurance has not influenced the way they think about expansion.

Hawkins highlighted his opposition to expansion when he first ran for office in 2013. In an interview with The Star Hawkins laughed off the suggestion that his work influenced his position on the issue. Medicaid populations, he said, are distinct from those on private insurance.

“When they say that they just don’t really know what they’re talking about,” Hawkins said.

“It’s not so much about my business as the reason I think the way I do, it’s some of the people I have worked with in other areas over the years. And I can tell you, when people go to work they derive a lot of satisfaction and self worth from working.”

Gossage regularly cites her insurance work opposing expansion. Certified on the affordable care act healthcare exchange Gossage works with some clients who may qualify for Medicaid if it was expanded. She argues the plans she can offer a low income individual without expansion are low cost and better than what Medicaid could offer them.

“It’s going to harm people that are in that category,” Gossage, who said she makes very little money working with that population, said.

As an alternative to expansion GOP leaders have instead pushed for $80 million in increased provider reimbursement rates and funding to reduce waitlists for Medicaid services.

“Really when you think about it I’m not sure why you would want it at the current reimbursement rates,” Hawkins said.

But advocates for expansion have said these should not be viewed as mutually exclusive of one another. Federal incentives available for expansion would, at least for the first couple of years, result in more money in the Kansas budget rather than less.

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

Senate Minority Leader Dinah Sykes, a Lenexa Democrat, said she sees only one pathway for lawmakers to be able to expand Medicaid.

“Realistically, it’s going to be replacing the Legislatures with legislators who will listen to Kansans and support Medicaid expansion,” she said. “They’re just so adamantly opposed.”