Legislators in Kansas devoted a great deal of time last week to debating whether or not to expand Medicaid, an option that was made available to the state by the Affordable Care Act (ACA). Presently, Kansas offers Medicaid coverage to pregnant women whose incomes are 166% of the federal poverty level (FPL) and below, and it offers Medicaid coverage to parents whose incomes are 33% of the FPL and below. Depending on the age of the child, the Kansas state Medicaid program also offers health insurance to children whose families make between 133% of the FPL and below and 166% of the FPL and below. The Kansas state Medicaid program does not offer health insurance coverage to childless adults.
How the Medicaid Expansion Would Affect Kansas
The ACA initially authorized a mandatory expansion of the Medicaid program that was set to begin on January 1, 2014. Under the ACA’s Medicaid expansion, virtually every non-elderly adult with an income of 138% of the FPL or below would be eligible for Medicaid. The federal government would pay for 100% of the ACA’s Medicaid expansion costs until the end of 2016. The federal government would then gradually decrease its share of funding for the Medicaid expansions every year until 2020, after which time it would pay for 90% of each state’s Medicaid expansion.
A 2012 Supreme Court decision made it optional for states to accept the ACA’s Medicaid expansion. Thus far Kansas has chosen not to adopt the ACA’s Medicaid expansion. Over 150,000 Kansans would be eligible for Medicaid if the state broadened its Medicaid program. According to a thorough analysis by Manatt, Phelps & Phillips (available here), a law and consulting firm, the expansion of Medicaid in Kansas should be budget neutral between 2016 and 2020. The debate in Kansas about whether to broaden Medicaid eligibility has been going on for years, and, as noted above, last week state lawmakers dedicated a lot of time to the issue. Here is what happened each day the state legislature convened.
On Monday, the Health and Human Services Committee of the Kansas House of Representatives passed a motion to postpone the consideration of a bill that would expand Medicaid in the state until April 3 or later. At the time the committee was debating whether to send the Medicaid expansion bill to the entire House so all Representative members could vote on it. One Republican lawmaker indicated that he believed the tabling of the bill meant that the House would not vote on it during the current legislative session.
But at least one House member who supported the Medicaid expansion did not give up. On Tuesday, Representative Jim Ward, a Democrat who is the House minority leader, filed a motion to move the Medicaid expansion bill from the Health and Human Services Committee to the broader House of Representatives. 70 members of the House needed to vote in favor of the motion in order to force a vote about the Medicaid expansion on the House floor.
On Wednesday, 83 members of the House voted to add a Medicaid expansion clause to another bill. The passage of this motion paved the way for the entire House to vote on whether or not to broaden Medicaid eligibility.
On Thursday, the House voted – by a margin of 81 to 44 – to broaden Medicaid eligibility in Kansas.
What’s Next? (said in the voice of Jeb Bartlet)
Next the Kansas Senate will consider whether or not to expand Medicaid. If members of the Senate Public Health and Wellness Committee provide enough support to the Medicaid expansion bill, it will move to the Senate floor and be voted on by the full Senate. People in favor of broadening Medicaid eligibility will speak to legislators at a hearing that is tentatively scheduled for March 20. Barring a date change, individuals who are against the Medicaid expansion are going to appear at a hearing that will occur on March 21.
In the event that the Kansas Senate passes a bill that broadens Medicaid eligibility, it would then go to the office of Governor Brownback, who would decide whether to veto or sign it. Although Governor Brownback has been hesitant to support the expansion of Medicaid in Kansas, on Thursday he indicated that he believed Congress should preserve this part of the ACA. In the event that the Senate passes the Medicaid expansion and Governor Brownback vetoes it, 84 members of the House and 27 members of the Senate would need to vote in favor of the measure in order to override his veto.
Featured image (of the Kansas House of Representatives) from http://www.civics.ks.gov/img/legislative/house-chamber.jpg
Steve Bowden is a health policy consultant and an MPH in health policy student at George Washington University. He had previously worked as a research assistant in the George Washington University Milken School of Public Health’s Department of Health Policy and Management. A version of this blog post was previously published at https://medicaidmattersblog.wordpress.com/.