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Medicaid expansion remains unsettled issue in Kan.

3/30/2013

By JOHN HANNA

AP Political Writer

TOPEKA -- Criticism of the federal overhaul of health care flows freely inside the Republican-dominated Kansas Statehouse, but Gov. Sam Brownback and legislators haven't formally rejected an expansion of the state's Medicaid program under the law championed by President Barack Obama.

Republican officials question whether the federal government will keep its promise to finance most of the cost if Kansas opts in. A Brownback administration study suggested that the state's Medicaid costs would balloon by nearly $600 million over the next decade if the state expanded the program in line with the Democratic president's policies.

Still, Brownback says he is leaving a decision on an expansion to legislators, and they haven't said no definitively. A House committee approved a resolution declaring opposition to an expansion, but the chamber has yet to debate it. Senators added a provision to a budget bill saying no money could be spent on an expansion without lawmakers' approval first -- but that's already seen as a given because of legislative oversight of spending.

Lawmakers' hesitation gives advocates of an expansion hope that they eventually can change enough minds to bring tens of thousands of uninsured Kansans into Medicaid.

"We're very optimistic that members of the Legislature aren't closing the door to expanding access to help cover more people," said Anna Lambertson, coordinator of the Kansas Medicaid Access Coalition, an alliance of 40 advocacy groups favoring an expansion.

The state's $3 billion-a-year Medicaid program covers health care for about 343,000 needy and disabled Kansans, with the federal government providing a majority of the funds. The 2010 federal health care law encourages states to expand their programs in an effort to decrease the number of Americans without health insurance, promising to pay all of the cost through 2016. While the federal government's share would decline, it would remain at 90 percent for 2020 and beyond.

A study commissioned by the state Department of Health and Environment said an expansion would pull 226,000 additional people into Medicaid by 2016 -- and result in government health coverage for about 20 percent of the state's population.

"We've got to be able to afford it -- that's the bottom line on it," Brownback told reporters last week.

Some Republican legislators oppose expanding government coverage because they fear it will lead thousands of Kansans out of the private health insurance market. The House resolution expresses concern about that possibility.

"We've got a good program at the present time that provides an important safety net," said Rep. David Crum, an Andover Republican and chairman of the House Health and Human Services Committee. "Do we want to potentially undermine that by over-expanding to the point that we can't support the bureaucracy and the cost?"

Also, with GOP supermajorities in both chambers, many legislators expect the overhaul will expand government's reach while failing to control insurance or health care costs.

"There are people who hope that the sheer weight of it and the cost bring it down," said Senate President Susan Wagle, a Wichita Republican.

Yet Brownback said this week that his administration is studying an alternative developed by Arkansas, where Democratic Gov. Mike Beebe announced recently that his state had received permission from the Obama administration to use funds for a Medicaid expansion to subsidize private insurance for poor residents. In Missouri, Democratic Gov. Jay Nixon has said he's open to the idea.

Advocates like Lambertson believe that a Medicaid expansion will bring meaningful health coverage to thousands of families now struggling with access to medical care and its costs. And the Kansas Hospital Association produced its own study showing that a Medicaid expansion would be a small net gain for the state -- and boost employment at health care facilities, helping the economy.

"People who are uninsured just, frankly, have worse health," Lambertson said. "We want to cover more people who are simply not getting the health care that they need, so they can lead healthier and more productive lives."

Wagle has been critical of the federal health care overhaul but said she's "absolutely" skeptical of the House resolution declaring opposition to a Medicaid expansion. She noted that Obama will remain in the White House through 2016.

"We need to remain flexible as a Legislature to continue to try to find ways to provide quality health care for Kansans and yet fit within this federal system and try and make it work," Wagle said.

And so, despite the strong criticism of the federal law from GOP officials, Lambertson said their lack of action to block an expansion so far represents "a positive sign in our favor."

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The resolution against expanding Medicaid is HCR 5013.

Online:

Kansas Legislature: http://www.kslegislature.org

Text of Senate's budget provision on Medicaid: http://bit.ly/YKYzZ2

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Follow John Hanna on Twitter at www.twitter.com/apjdhanna