After multiple unsuccessful attempts by Congress to repeal the Affordable Care Act, some gubernatorial candidates have set their sights on expanding Medicaid coverage to more low-income Kansans.
Medicaid expansion under the Affordable Care Act provides health insurance coverage to adults who make up to 138 percent of the federal poverty line, and the federal government has to cover 90 percent of the cost. Adults who benefit from Medicaid expansion make too much money to qualify for the existing program but not enough money to qualify for subsidies to buy individual insurance policies, leaving them in a gap.
Legislators passed an expansion bill this spring, but Republican Gov. Sam Brownback vetoed it. The Legislature failed to override him.
Expansion, which carries support from many Kansans, could come up in the gubernatorial primary campaigns. Democrats are uniformly in favor of the program, but Republicans remain split.
Secretary of State Kris Kobach, Lt. Gov. Jeff Colyer, Insurance Commissioner Ken Selzer and Wichita businessman Wink Hartman all oppose expansion. Kobach and Colyer have been considered front-runners in the contest for the Republican nomination.
Colyer, an Overland Park surgeon, said he thought Congress needed to act on repealing and replacing the Affordable Care Act, which could mean eliminating the funding for Medicaid expansion. He said he thought Congress should give states more flexibility to design their Medicaid programs. Congress has considered administering Medicaid through a block grant with fewer regulations.
“Whatever comes out of Washington, we would like to have state flexibility rather than a straight-jacket,” Colyer said.
He said he thought Kansans had been clearly opposed to the Affordable Care Act.
Selzer, too, said he thought Congress would act to dismantle the ACA. He said he didn’t favor expansion, and a hypothetical program would have to have extensive work requirements for beneficiaries. Even so, he said he thought the ACA was unsustainable.
“Should that happen, it makes Medicaid expansion at the state level a moot question,” Selzer said.
In a statement, Kobach spokeswoman Samantha Poetter objected to the program’s cost and inclusion of nondisabled adults. Opponents of expansion have pointed to larger-than-expected enrollment in expansion states to argue against it, but according to the nonpartisan Kaiser Family Foundation, those states saw economic benefit.
“Bankrupting the state to expand Medicaid will end up hurting the vulnerable most of all,” Poetter said. “Kris’ aim is to make sure Medicaid serves its intended purpose of covering those who truly need it, not able-bodied adults.”
Hartman said in a statement he thought the program prioritized nondisabled adults and made waiting lists longer. The disability community contested that claim during legislative debate this spring.
Some Republicans, however, may be more favorable to expansion. Former state Rep. Mark Hutton said he thought debates got hung up on labels, like “Obamacare.” He said lawmakers needed to do something to help Kansans who are working but can’t afford health care.
“But we’ve not had anybody sit down and say, ‘What can be a good Kansas solution to this?’ ” Hutton said.
Former Rep. Ed O’Malley and former Sen. Jim Barnett both favored the program. O’Malley said Kansans’ federal tax dollars were already paying for expansion in other states and they should benefit from that funding.
Gubernatorial candidates on the democratic side were united in their support of Medicaid expansion. Former Wichita Mayor Carl Brewer, former Secretary of Agriculture Josh Svaty, House Minority Leader Jim Ward and Olathe physician Arden Andersen all favor the program.
Svaty said people who would benefit from Medicaid expansion, in many cases, are working.
“These people are doing everything that you would want them to do,” Svaty said. “They’re working hard, they’re providing for their family and they simply do not make enough money to afford health care.”
Ward said he thought providing insurance for those people left in the health insurance gap was “morally right.” He said he thought it would also serve as an economic boon to the state.
Not expanding has cost the state’s economy to the tune of $1.7 billion, Brewer said in a statement. He said he supported the program because “too many Kansans are needlessly suffering.”
Potential federal action on the ACA wasn’t a deterrent for Ward. He said expansion states would have won out in several congressional proposals to repeal the ACA.
“So, regardless of the change in law, I think expanding gives us a better chance to be successful,” Ward said.