A push to expand Medicaid has Kansas' governor embracing politics and going against her brand

TOPEKA, Kan. — Democratic Gov. Laura Kelly is becoming more aggressive and overtly political in pursuing Medicaid expansion in Kansas, as the Republican-controlled Legislature prepares to open its annual session Monday after five years of failed efforts to extend health care coverage to even more another 150,000 people.

Kelly faces leaders of the Republican Party's supermajorities, whose priorities are cutting income taxes and reining in local property taxes, not expanding Medicaid.

But Kelly's new plan includes hitting Republicans who oppose expansion hard in races for House seats later this year, an approach that ends years of self-branding as a bipartisan problem-solver who doesn't care about politics.

“My previous approach, which was always to bring people together and work together and build consensus and then put good policy on the agenda, hasn't worked,” Kelly said during a recent interview.

“A more aggressive approach and – to be more direct, a more political approach – could be the answer,” she added.

For months, Kelly has traveled around the state holding press conferences and roundtables to build support for Medicaid expansion. She said she modeled her campaign after Democratic Gov. Roy Cooper's campaign in North Carolina, where a Republican Party-dominated legislature expanded coverage starting Dec. 1.

Kansas is one of only 10 states that have not expanded Medicaid in accordance with the federal Affordable Care Act of 2010, which promises federal funds to cover 90% of new costs. In two other states, Georgia and Mississippi, Republicans have shown willingness to talk about expansion this year, so the issue is not dead.

In Kansas, conservative opposition is rooted in small-government beliefs and decades of skepticism about social services. In the fall, House Speaker Dan Hawkins and Senate President Ty Masterson, both Wichita-area Republicans, derided Kelly's events with business leaders, hospital administrators and health care advocates as a “Welfare Express Tour” for “more dependence on government.”

“The point is that we don't use taxpayer dollars to fund free health care for a new population of healthy, childless adults who don't want to work,” Hawkins said in an email.

For some Kansas residents, the issue is over.

In Newton, 46-year-old Robyn Adams works 15 to 20 hours a week while caring for her 15-year-old daughter and uses a manufacturer's program to avoid paying $1,500 every two weeks for injections to treat her rheumatoid arthritis. to treat.

She lost Medicaid coverage by working longer hours, but not enough to qualify for federal subsidies for private insurance. Even paying a $40 copay before a doctor's visit can be a financial challenge, so paying a higher monthly insurance premium is out of the question, she said.

“We need insurance too,” she said of low-income families. “Without the expansion, I don't know – a lot of families are going to be in trouble.”

To attract votes from the Republican Party, Kelly has mandated that those newly eligible for Medicaid verify annually that they are working. But Masterson told reporters: “It really doesn't change the underlying facts.”

In Kansas, childless adults without disabilities are not eligible for Medicaid. Parents like Adams are not covered if their household income reaches 38% of the federal poverty level. For a single parent of one child, this is less than $7,500; for a family of four it is $11,400.

An expansion would make both groups eligible if they earn up to 138% of the federal poverty level. A single, childless adult could earn $20,100; a single parent and one child, about $27,200; and a family of four, $41,400.

Of those eligible, 73% belong to families with at least one full- or part-time worker, according to KFF, the research organization formerly known as the Kaiser Family Foundation. Many work in the service industry and others are independent contractors, said Sean Gatewood, a former member of the Kansas House and spokesman for the KanCare Advocates Network, a pro-expansion coalition.

Kelly's plan would increase the cost of the Kansas Medicaid program by 31%, about $1.35 billion per year. However, federal funds would cover all but $135 million, while the state would impose fees on hospitals and major private health insurers for most of the rest.

The federal government is also offering a financial bonus to the remaining non-expansion states. A promise of an additional $1.8 billion over two years was crucial for Republican lawmakers in North Carolina. Kelly's office expects Kansas to receive a total bonus of between $370 million and $450 million.

But even if there is enough support to pass a bill expanding eligibility, Hawkins, Masterson and their allies could even block a plan from approval committees. Democrats' attempts to offer expansion plans during debates on other measures have been excessively excluded, and even Republicans who support expansion have backed their leaders on that point.

Still, Kelly and other advocates see plenty of reasons to continue, including the success of North Carolina's governor.

Cooper argued that Republican lawmakers in his state were feeling pressure from an unusual coalition that included statewide chambers of commerce and “republican crime-fighting sheriffs,” who felt they were dealing with too many people who simply lacked access to health care. needed, 'and not to handcuffs. ”

As for the non-expansion states, Cooper said at a news conference: “I hope they can learn some lessons from the coalitions of people that we've been able to put together to try to succeed.”

___

Associated Press writer Gary Robertson in Raleigh, North Carolina, also contributed.