Kansas Senate Republicans swiftly shut door on proposed Medicaid expansion amendment

TOPEKA — Efforts to expand Medicaid in Kansas were dealt a blow Wednesday after an amendment to do just that was rejected largely along party lines on the Senate floor.

The proposed expansion came in the form of an amendment to a bill increasing funding for community mental health clinics and addressing telemedicine treatment. The amendment sparked the first formal debate on the issue this session, with Republican legislators signaling the idea would not gain much traction in 2021.

Opponents of the amendment raised concerns that it had not been raised or vetted in committee and questioned the cost of expansion. Supporters countered that the expansion would complement efforts within the bill, and costs would be offset through federal funding and secondary economic gains.

Senate Minority Leader Dinah Sykes, D-Lenexa, introduced the amendment to Senate Bill 238 to force some discussion during this legislative session. More than 100,000 Kansans stand to gain health care coverage through such action, she said.

“We need to realize that Kansans will be healthier if they have insurance. Going to be less cost to insurance and allowing them to miss work less, and they’re going to be able to properly manage that care instead of going to the emergency room every time they have an issue,” Sykes said.

The amendment failed 12-23 largely along party lines, with several Republicans who support Medicaid expansion voting against the amendment for fear it would kill the underlying bill. Sen. Jon Doll, R-Garden City, and a supporter of expansion, voted in favor of the amendment.

Kansas is one of 12 states yet to expand KanCare — the state’s privatized version of Medicaid — since the Affordable Care Act became law in 2010. A bipartisan effort to expand the program died last year after the House rejected an anti-abortion constitutional amendment prompting then-Senate President Susan Wagle to declare Medicaid efforts dead.

According to a recent report by the Kansas Health Institute, 126,000 new Kansans would enroll in KanCare if Medicaid were to be expanded in January 2022.

Legislators had yet to have a formal discussion on the policy this session. A bill carrying out Gov. Laura Kelly’s proposal to fund Medicaid Expansion through the legalization of medical marijuana was introduced in the House Committee on Federal and State Affairs last week.

Even without medicinal cannabis revenue, proponents of Medicaid expansion have long held that the costs of any expansion would be covered by billions of dollars in secondary economic benefits, as well as through federal funding. A provision in the ACA requires the federal government to cover 90% of expansion costs.

However, amendment and expansion skeptics said it would be too expansive and cast doubt on the economic benefits Democrats touted. Sen. Richard Hilderbrand, R-Galena, and chairman of the House Public Health and Welfare Committee, where the bill was introduced, questioned their faith in “trickle-down” economics.

“The other side deplores trickle-down economics, but now they want you to believe in trickle-down economics,” said Hilderbrand. “They want you to believe that the private sector doesn’t work. It’s the public sector for trickle-down economics to work. I don’t believe in trickle-down economics because I think everything trickles down, but there are ways that you can do it effectively.”

Hilderbrand said efforts were best spent addressing those currently enrolled in Medicaid and issues they may have with receiving the necessary care. He also said the amendment was not raised in committee and thus not vetted properly.

Supporters noted the amendment language is similar to that of bills introduced in past years.

Hilderbrand and others against the amendment also said the ACA was at the root of many issues Democrats said the expansion would solve. Sen. Mark Steffen, R-Hutchison, took to Twitter during the debate to express his opposition.

“Medicaid is a failing government program that causes instability in our health care system,” Steffen said. “The thought of expanding to able-bodied men and women is ridiculous.”

Sen. Pat Pettey, D-Kansas City, Kansas, disagreed with assertions Medicaid was hurting the health care system. Among the areas of concern Medicaid expansion could address was financial difficulties in many hospitals across Kansas.

“We know one of the biggest expenses for hospitals right now is uncompensated care,” Pettey said. “All of our hospitals have been advocating for Medicaid expansion for the last seven years because of how it will help their bottom line and that in turn helps to provide quality health care across the state of Kansas”

Several Republicans who have supported Medicaid expansion in the past chose to oppose the amendment for fear it would kill any chances of a critical mental health bill. Sen. Carolyn McGinn, R-Sedgwick, said she would like to debate expansion in bill form, which she could properly vet.

“The likelihood of substitute for Senate Bill 238 moving forward with this amendment does not look promising,” McGinn said. “We have a mental health crisis today, and I do not think we even know the impact of COVID-19 on our families and communities. We need Senate Bill 238 to provide high quality and timely behavioral health treatment across Kansas.”

The underlying bill, which some called the most important piece of mental health legislation in 30 years in Kansas, received first-round approval from Senators on a voice vote after the amendment was voted down. The body had yet to take a final vote on the mental health measure.