Democrats are preparing for another run at Medicaid expansion when lawmakers return, hoping they can offer changes to conservatives to gain their support.
But opponents vow to fight, saying there are no modifications that would win them over.
The Legislature will reconvene May 1. Supporters of expansion mounted an unsuccessful effort earlier this month to override Gov. Sam Brownback’s veto of a bill that would have increased eligibility for the program.
Medicaid covers people who earn too little to buy insurance through the federal health care exchange but too much to otherwise qualify for the program.
Supporters fell three votes short of the 84 needed to override in the House and send the proposal to the Senate.
Lawmakers face a challenging agenda when they return. They must create a new school finance formula and close budget shortfalls of around $1 billion over the next two years.
Sen. Ty Masterson, R-Andover, who opposes expansion, says taking another run at it isn’t impossible. But he said other issues like school finance and taxes could essentially crowd out Medicaid expansion for the remainder of the session.
“It would have to rear its head up in some type of conference (committee),” he said. “The process is bent against it.”
The number of unresolved issues is why some lawmakers say the Legislature should not spend time on expansion.
“With the perilous budget situation we have in Kansas, the recent school finance decision and the continued uncertainty at the federal level, now is not the time to take upon a multi-year commitment that our state may not be able to afford,” 16 Republican lawmakers said in a joint statement after voting against overriding the veto.
But House Minority Leader Jim Ward, D-Wichita, thinks there’s room for Medicaid expansion, too.
“We have tools in the toolbox to bring it back up,” Ward said. “The goal is to make sure we have 84, 85 solid votes.”
Supporters of expansion could use a procedural maneuver to force the House to debate legislation. Lawmakers would then offer an amendment that includes expansion.
The first time around, the bill passed both chambers with strong majorities. The vote was 81-44 in the House and 25-14 in the Senate.
The margin was still short of the two-thirds support needed to override the governor’s veto.
Ward described changes that supporters may be willing to make to bring more lawmakers on board.
In his veto message, Brownback said the bill would ensure an increase in state and federal Medicaid dollars going toward abortion providers such as Planned Parenthood.
“Even though it is illegal to use federal funds in any shape or form for the performance of abortion, put that specific language in there so you take that red herring the governor threw in there off the table,” Ward said.
Supporters may also be willing to talk about a work requirement for able-bodied adults on Medicaid, he said. Brownback has said he wants a work requirement in any expansion legislation.
Brownback has also said that expansion must be budget neutral and that a waiting list for people seeking disability services must be eliminated.
“Those factors remain and those factors remain addressable,” Brownback told reporters last week.
Kansas is one of 19 states that have not expanded Medicaid. The federal government covers 90 percent of the cost of expansion, while the states pay the remaining 10 percent.
The bill vetoed by Brownback would have expanded eligibility for the program for people with incomes of up to 133 percent of the federal poverty line, which is $24,600 for a family of four.
David Jordan, director of the pro-expansion group Alliance for a Healthy Kansas, said supporters will likely have to find a proposal that can garner the support needed to overcome the governor’s veto rather than developing a plan that Brownback will approve.
“I’m not holding out much hope the governor is going to get serious about doing the right thing for Kansans as it relates to expanding KanCare,” Jordan said of the state’s Medicaid program.
“I think at the end of the day, a lot of the legislators were elected to help find solutions on tax and budget, school finance and expanding Medicaid.”
Opponents of expansion are prepared to fight any new efforts, however.
Jeff Glendening, Kansas state director for Americans for Prosperity, said Medicaid expansion is unaffordable no matter how it’s drawn up.
“We need to preserve the safety net for the most at-risk people for whom it was intended and not dilute the health care they will receive by adding more Medicaid participants who are able-bodied, working-age adults,” Glendening said.
Jordan said recent news about a struggling Kansas hospital may intensify efforts to expand.
The closing of St. Francis Health Center is imminent, the Topeka Capital-Journal reported last week. The hospital has been searching for a buyer for nearly a year and has cited the lack of Medicaid expansion as a factor.
Mercy Hospital System closed its hospital in Independence in 2015. Medical centers in Wellington and Fort Scott have also faced difficulties.
Rep. Fred Patton, R-Topeka, is the kind of lawmaker that supporters of expansion hope to sway. Patton was initially a “no” on expansion but after a weekend of intense lobbying voted to override Brownback’s veto.
“I have serious concerns with provisions in this plan,” Patton said in a statement explaining his vote. “However, with one local hospital for sale and both absorbing increasing financial pressures, I am also concerned with ensuring health care access for our families.”
It’s unclear whether a major hospital closing would alter Brownback’s position on expansion.
“We’ll look and see whatever situation comes up,” Brownback said. “It sure reiterates the difficulty of Obamacare because we’ve had big changes and difficulties under Obamacare.
“Again, we’ll examine those situations.”