TOPEKA, Kan. — Pressure is likely to build next year in Kansas to expand Medicaid to cover thousands of uninsured residents, despite the Republican-dominated Legislature's displeasure with the federal health care overhaul.
Advocates for the needy and consumers are promising to push for an expansion once lawmakers convene their annual session Jan. 13. The nonpartisan Kansas Health Institute estimates an expansion would cover more than 85,000 people, almost a quarter of the state's uninsured residents.
Supporters face Republicans' strong opposition to the 2010 health care law championed by President Barack Obama, a Democrat, and GOP skepticism that the federal government will keep promises to finance most of the cost. The rocky rollout of the federally run online health insurance marketplace also toughened some Republicans' resolve.
But for Floydie Oliver, 52, a recently unemployed Pittsburg resident, the key question is whether legislators consider the struggles of uninsured Kansans like her. She and her 66-year-old husband are living on his retirement and Social Security benefits as she looks for a new job, relying on a community health clinic for care and dealing with chronic back pain.
"I can't afford to go to specialists or things of that nature," she said. "It's all about not having enough money to afford things."
The federal law requires most Americans to obtain health coverage or face tax penalties starting next year, and it imposes minimum-coverage mandates for insurers. The law provides subsidies for millions of Americans living above the poverty level and contemplates states expanding their Medicaid programs to cover people living at or below the poverty level, or $23,550 for a family of four.
But in its 2012 ruling upholding most of the health care law, the U.S. Supreme Court said the federal government couldn't compel states to expand Medicaid. Kansas legislators added a provision to budget legislation this year blocking an expansion through June 2015.
"Kansans are very clear. We don't want to expand Obamacare," said Lt. Gov. Jeff Colyer, a reconstructive plastic surgeon who often is the Brownback administration's chief spokesman on health issues. "That's the long and the short of it."
Brownback is critical of the federal health overhaul, and he allowed the Medicaid-expansion ban to stand when he signed this year's budget legislation — instead of using his power to veto individual items. But during an interview earlier this month, he said he's still watching the Obama administration's implementation of the federal law because "they still make more changes."
"That's why I've not declared, you know, either we're going to do it or we're not going to do it," he said of a Medicaid expansion.
Senate Minority Leader Anthony Hensley, a Topeka Democrat, said Brownback has "dropped the ball" on the expansion because his leadership could combat "the whole notion that you would be looked at as endorsing Obamacare." Other states with GOP governors, including Arizona, New Jersey, Ohio and Pennsylvania, plan to expand Medicaid.
The health care law says the federal government will fund all of the expansion through 2016 and cover at least 90 percent of the cost after that.
"The arguments I've heard against it just don't make sense," said Insurance Commissioner Sandy Praeger, perhaps the only prominent Kansas Republican to praise the federal health care overhaul.
In Kansas, able-bodied adults without children don't qualify for Medicaid, and those with children cannot obtain their own coverage unless their household incomes are below a third of the poverty level — or $7,536 for a family of four.
Sean Gatewood, interim executive director of the Kansas Health Consumer Coalition, said the Medicaid expansion and subsidies for private insurance for better-off families are designed to "work together" to help the uninsured. He said his group will "absolutely" push for a Medicaid expansion because without it, thousands of Kansans will remain ineligible for Medicaid but too poor for subsidies.
A study last year commissioned by the Kansas Hospital Association suggested an expansion would create new jobs and lower some state costs, resulting in a net financial gain for the state. Also, hospitals stand to lose some of their federal funds because the health care law assumed Medicaid would expand.
However, a study commissioned last year by the Brownback administration suggested that the state would spend an additional $600 million over 10 years if it expanded Medicaid.
Both studies assumed the federal government kept its funding promises. Senate Public Health and Welfare Committee Chairwoman Mary Pilcher-Cook, a Shawnee Republican, said states cannot rely on those promises, given the federal government's ongoing budget problems.
As for helping uninsured Kansas, Pilcher-Cook pointed to a Kansas law that took effect in July, allowing insurers to offer cheaper, "mandate-lite" insurance plans. People buying them still would pay a federal penalty, but Pilcher-Cook said doing so still could be cheaper than buying a federally sanctioned plan. She said if the state promoted such options, demand would build and companies would seek to offer the plans.
She added that states should be wary of getting further entangled with the federal government following the online insurance marketplace's problems.
"It's so chaotic that it would be foolish for the Legislature to do something at this point," Pilcher-Cook said of the Medicaid expansion.