Over the years, Gov. Laura Kelly has tested various ways to cajole the Republican Legislature into expanding Medicaid.
Three years ago, Kelly teamed up with a top Republican in the Kansas Senate on a Medicaid expansion plan that was blocked in a committee amid an abortion debate.
A year later, Kelly made another run at Medicaid expansion, this time promising to use revenue from legalizing medical marijuana to pay for the program.
The proposal never got off the ground because it faced steadfast opposition from Republican leadership in the Legislature.
Kelly is returning to the Legislature with her sixth Medicaid expansion plan, this time with a work requirement, an obvious nod to Republicans who have resisted the expansion idea throughout her term as governor.
“For each of the five years I’ve been in office, I’ve had a bill introduced to expand Medicaid with support from both sides of the aisle,” Kelly said Thursday in unveiling the new bill at Holton Community Hospital.
“Each year it has been rejected by Senate and House leadership. I won’t give up.”
“I truly hope that the legislative leadership will not stand in the way of doing what’s right for Kansas and what everyday Kansans overwhelmingly say they want — which is for Medicaid to be expanded across the state.”
Kansas is now one of 10 states that haven’t expanded Medicaid, and the top Republicans in the Kansas House and Senate remain opposed to the idea.
North Carolina, with a Democratic governor and a Republican-controlled Legislature, was the most recent state to expand government health care for the less affluent.
It’s been reported that Georgia is the only state with work requirements in place, an issue that’s already giving Medicaid expansion supporters in Kansas heartburn.
Expanding the program would provide health insurance to an estimated 150,000 Kansans who make too much money to qualify for Medicaid and earn too little to pay for private health insurance, the governor said.
The governor has mounted an aggressive campaign in recent months to get Medicaid expanded leading up to the 2024 legislative elections.
She’s visited almost a dozen cities across the state, including Kansas City, Parsons, Emporia, Salina, Garden City and Pittsburg.
She’s also started a new political action committee that is now raising money and could weigh in on the Medicaid expansion issue in the coming months.
She alluded to the political implications of Medicaid expansion when rolling out the legislation on Wednesday, emphasizing that polls show Medicaid expansion is overwhelming popular among Kansans.
“As we go into 2024, we’re just not going into another legislative session,” she said. “We’re going into a legislative session during an election year.”
“I anticipate if this does not pass the Legislature this session, it will be the No. 1 issue going into the 2024 campaigns for the Legislature.”
Repubican leaders are undeterred. Senate President Ty Masterson called the governor’s proposal a “fake work requirement” and a “tax scheme.”
The governor’s proposal would require an individual applying for Medicaid under expansion to submit proof of a work or community engagement.
The beneficiary would be required to provide proof at the time of renewal a year later to remain eligible.
The proposal would include exceptions for full-time students, full-time caregivers, veterans or those suffering from medical conditions.
“This work requirement will make sure that no one is taking advantage of the program without doing their part,” Kelly said.
It remains to be seen whether the Centers for Medicare & Medicaid Services would approve the work requirement.
Former President Donald Trump’s administration tried to put its own imprint on Medicaid by approving waivers that allowed 13 states to impose work and reporting requirements as a condition of Medicaid eligibility, according to the Kaiser Family Foundation.
Of the 13 states that had approved work requirements, only Arkansas implemented such requirements with consequences for noncompliance, according to KFF.
Other states that started work requirements didn’t cut off anyone who did not comply and instead paused implementation because of litigation or the pandemic.
But KFF reported that courts struck down many of those approvals.
KFF noted that the U.S. Supreme Court dismissed pending litigation in Arkansas and New Hampshire due to the expiration of Arkansas’ waiver as well as the Biden administration’s earlier withdrawals of the approved work requirement waivers.
Kelly said the work requirement she is proposing is different from any other state.
“A lot of other states, when they have put in work requirements, it has been monthly validation of working,” she said.
The Kelly approach calls for Medicaid recipients to show they are working every year when they renew eligibility for coverage, which the governor said she hopes will be enough to satisfy the federal government.
Kelly acknowledged that she’s somewhat uncomfortable with the work requirement.
“I’m not crazy about the work requirement. Never have been,” she said.
“But we have a reality of needing to get this passed,” Kelly said. “I ran on being middle of the road…and operating that way. That’s what we’re doing here.”
Kelly said she’s merging ideas from two political perspectives that not everyone would like but ideally would be enough to get it passed in the Legislature.
The governor said the expansion plan she’s proposing would be revenue neutral.
Ninety percent of the cost will be paid for by the federal government. If at any point the federal match for expansion falls below 90%, the program will be ended.
The state is responsible for the remaining 10%, some of which would be paid for with a hospital surcharge.
Kelly’s proposal creates a surcharge that would be collected from all hospitals and capped at $35 million a year.
Revenue from the surcharge shall be used to offset the state’s share of expansion.
The fee will be delayed for two years so rural and community hospitals can enjoy immediate benefits of Medicaid expansion to get on a more stable footing.
The Kansas Hospital Association said it was still reviewing the proposal.
“While Kansas hospitals are supportive of Medicaid expansion, we are sensitive to any additional financial pressures, including a hospital surcharge,” said Cindy Samuelson, spokesperson for the hospital association.
“We will be evaluating the impact Medicaid expansion and the hospital surcharge will have on our members,” Samuelson said.
“We look forward to continued dialogue to make Medicaid expansion a reality in Kansas.”
The governor’s proposal drew a tepid response from advocacy groups that have long lobbied the Legislature for Medicaid expansion.
“Implementing work requirements creates barriers to coverage and hoops for Kansans to jump through to get health coverage they qualify for as part of expansion,” said David Jordan, president and CEO of the United Methodist Health Ministry Fund.
“No Kansan should need to jump through unnecessary hoops to access health care. We should be breaking down barriers to care instead of implementing policies that result in the loss of health coverage,” Jordan said in a text message.
April Holman, executive director of the Alliance for a Healthy Kansas, said her group had issues with the work requirement as well.
“Although we are very supportive of Medicaid expansion and appreciative of the work that the governor has done, we are not able to support the portion of her proposal that would include the work requirements,” Holman said in an interview.
House Speaker Dan Hawkins, a staunch opponent of Medicaid expansion, was not swayed by the latest plan from the governor.
“While I appreciate the governor’s newly found support for work requirements for welfare benefits, this is nothing more than smoke and mirrors,” Hawkins said.
“Gov. Kelly most surely knows that the Biden administration has not approved any Medicaid work requirement and proactively revoked every single work requirement approved previously,” Hawkins said.
Meanwhile, House Minority Leader Vic Miller criticized Republicans for not moving to expand Medicaid.
“There’s one word to describe Republican leadership: ‘cruel,'” Miller said in a statement.
“Kansans across the state are suffering and quite literally dying from a lack of healthcare.
“Republicans could attempt to defend their position in a fair debate, but Speaker Hawkins refuses to allow substantial discussion. He knows we will win the debate every time.”
The governor’s plan also provides Medicaid coverage for any person who is incarcerated if they are eligible for Medicaid under state or federal law, which was another provision of the proposal that Hawkins criticized.
“Good news Kansas taxpayers – Gov. Kelly is more worried about taking care of Kansas inmates than she is about the rising costs this will add for law-abiding citizens,” Hawkins said in his weekly newsletter on Friday morning.
The governor’s plan, he said, “means you’ll pay more for health care so the guy who broke into your car will get free health coverage.
“Sometimes reality is stranger than fiction folks.”
