A panel of lawmakers staked out conservative ground for Medicaid expansion on Wednesday, recommending work requirements for any proposal to expand medical coverage for the less affluent.
The panel also recommended that the Legislature allow Medicaid providers to opt out of providing medical services that they object to on religious grounds, such as providing birth control.
The special committee on Medicaid expansion included those recommendations in its report to the upcoming session of the Legislature.
The panel did not recommend an expansion bill, although it spent Tuesday and Wednesday discussing Senate Majority Leader Jim Denning’s expansion proposal, which will likely be the starting point for debate in the Senate next year.
“I don’t know where this is going,” Democratic state Sen. Barbara Bollier said of the recommendations.
“I was intrigued there was no recommendation of a draft of a bill that we spent the entire time discussing,” she said.
The recommendations don’t carry the power of law, but they provide some guidance for the Legislature to follow when it debates Medicaid expansion next year.
While the panel only made recommendations Wednesday, its suggestions need to be viewed seriously, said April Holman, executive director of the Alliance for a Healthy Kansas.
“All of these recommendations are important, but it’s hard to tell exactly what shape these recommendations will take,” Holman said. “We’re kind of in uncharted ground. We take it seriously.”
The proposed work requirements — 20 hours a week or 12 college credit hours — might prove to be the most controversial in the long run if the Legislature adopts them.
Supporters of work requirements believe public assistance should encourage employment.
Critics say work requirements don’t improve public health and are designed to remove people from the program.
Almost 20 states have tried to adopt work requirements for Medicaid expansion, although Arizona and Indiana recently halted those rules.
A federal judge has already blocked work requirements in Arkansas, Kentucky and New Hampshire because the federal government didn’t consider how the rules would affect the primary goal of Medicaid — to provide coverage to the poor.
Last month, a federal appeals court heard arguments on the work requirements.
The appeals court judges also questioned whether the work requirements violated the objective of the Medicaid program to provide medical coverage to the needy.
Republican state Rep. Will Carpenter made the recommendation to include the work requirements in the committee’s report.
He said he wasn’t bothered by court rulings that have struck down the work requirements elsewhere.
“We have a lot of liberal courts around,” Carpenter said. “I don’t see a problem with it at all. The courts are holding it up.”
A study by Harvard researchers also found the work requirement in Arkansas caused a loss in Medicaid coverage while increasing uninsured rates.
For instance, the share of Arkansans 30 to 49 years old with Medicaid or marketplace coverage fell to about 64% in 2018 from about 71% in 2016.
The uninsured rate in that same age group increased to about 15% in 2018 from about 11% in 2016.
They also found no significant changes in employment because of the work requirement.
The conscientious objector recommendation came at the urging of the Kansas Catholic Conference.
The group representing the state’s Catholic bishops conditioned its support for Medicaid expansion on the legislation including protections for religious and professional conscience objections.
Chuck Weber, executive director for the Catholic Conference, said the state Supreme Court decision finding there’s a right to an abortion in the state constitution makes the protections necessary.
The decision, he said, opened a “Pandora’s box” of legal and ethical uncertainty for health care providers.
“Will physicians and hospitals seeking Medicaid reimbursement status be compelled by the law to perform abortions? Physician-assisted suicide protocols?” he asked. “So there is a pressing question of conscience here.”
Legislative staff attorneys noted that a week ago, a federal judge in Manhattan struck down a Trump administration rule protecting health care workers who cited a conscientious objection for refusing to provide services such as abortion. They told lawmakers that a state law might face a similar challenge.
Carpenter said he is trying to protect people of faith.
“People have religious liberties and they need to be able to pursue those,” he said.
State Health Secretary Lee Norman cautioned lawmakers that they were encroaching on dangerous ground.
He used a hypothetical of a woman suffering complications from using birth control whom physicians might not want to treat based on their moral opposition to contraception.
Norman also warned that new limits on Medicaid providers would make it hard to build a network of providers.
“The more ethical boundaries we artificially put around professionals,” he said, “the harder it’s going to be to build a network to take care of our patients in the state of Kansas.”
