The Democrat Governor of Kansas Laura Kelly has pushed to expand taxpayer-funded Medicaid in her state.
Kelly is making the push as the Republican-controlled Legislature opens its annual session on Monday.
The governor is seeking a more aggressive and openly political push to expand Medicaid following five years of failed efforts to expand state health coverage to cover another 150,000 people.
Kelly faces leaders of GOP supermajorities whose priorities are to cut income taxes and rein in local property taxes, not to expand Medicaid.
But Kelly’s new plan includes hitting expansion-opposing Republicans hard later this year during races for legislative seats, an approach that cuts against years of self-branding as a bipartisan problem-solver who doesn’t care about politics.
“My previous approach, which has always been to try to bring people together and work collaboratively and come up with consensus and then get good policy on the books — that hasn’t worked,” Kelly said during a recent interview.
“Taking a more aggressive approach and — to be direct, a more political approach to it — might be the answer,” she added.
For months, Kelly has toured the state for news conferences and roundtables to build support for Medicaid expansion.
She said she modeled her campaign on one by Democrat Gov. Roy Cooper in North Carolina, where a GOP-dominated legislature expanded coverage as of December 1.
Kansas is among only 10 states that have not expanded Medicaid in line with the 2010 federal Affordable Care Act.
The act promises federal funds to cover 90% of the new costs.
In two other states, Georgia and Mississippi, top Republicans have signaled a willingness to discuss expansion this year so the issue isn’t a dead letter.
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 advocates as a “Welfare Express Tour” for “more government dependency.”
“It’s about not using taxpayer dollars to fund free healthcare for a new population of able-bodied childless adults who don’t want to work,” Hawkins said in an email.
To attract GOP votes, Kelly has mandated that those who would newly qualify for Medicaid verify annually they are working.
But Masterson told reporters, “It really doesn’t change the underlying facts.”
Kelly’s plan would increase the cost of the Kansas Medicaid program by 31%, about $1.35 billion a year.
However, federal taxpayer funds would cover all but $135 million, with the state imposing fees on hospitals and large private health insurance companies for most of the rest.
The federal government also is offering remaining non-expansion states another financial bonus.
A promise of an additional $1.8 billion over two years was crucial for GOP 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 can keep a plan from even clearing committees.
Democrats’ attempts to offer expansion plans during debates on other measures have been ruled out of order, and even Republicans backing expansion have stood with their leaders on that point.
Yet Kelly and other advocates see plenty of reasons to keep pushing, including North Carolina Gov. Cooper’s success.
Cooper argued GOP lawmakers in his state felt pressure from an unusual coalition that included rural chambers of commerce and “tough-on-crime Republican sheriffs” who felt they were dealing with too many people who simply needed access to health care, “not handcuffs.”
As for non-expansion states, Cooper said in a news conference:
“I hope that they can take some of the lessons of the coalitions of people that we’ve been able to put together to try to succeed.”