TOPEKA — Just two minutes into her first speech as Kansas governor-elect, Laura Kelly outlined Medicaid expansion as one of her top priorities.
"It’s long past time to expand Medicaid, so that more Kansans have access to affordable healthcare," she told a cheering crowd Tuesday in Topeka. "Our rural hospitals can stay open, and the tax dollars that we’ve been sending to Washington can come back home to Kansas to help our families, our state."
The fact that the state's leader is a proponent of expanding KanCare, the state's Medicaid program, sent a wave of good feelings through area health care officials who have fought to unlock health insurance coverage for an additional 150,000 Kansans. The state almost expanded in 2017, when the House and Senate moved legislation forward only to see it vetoed by then-Gov. Sam Brownback.
Even though Kelly's election brings new hope to the process, Tom Bell, president and CEO of the Kansas Hospital Association, cautioned proponents not to rest on their laurels.
"Supporters of Medicaid expansion need to be every bit as active with their legislators as they have been in the past," Bell said. "We have a governor who will be pushing for it, but she's going to need help."
Randy Peterson, Stormont Vail Health president and CEO, acknowledged concerns. The makeup of the Legislature changed with the midterm election, he noted, and that could raise new dynamics around Medicaid expansion. Some legislative votes, he said, may shift because there is now a governor who won't veto the expansion.
In addition, the Medicaid work requirement might raise disagreements, he said.
"The federal administration and (Centers for Medicare and Medicaid), I think, have tended to like Medicaid expansion plans that have work requirements in them," Peterson said. "Is that going to be a hot button for some legislators one way or the other?"
"It's kind of those 'devil's in the details' on how it gets packaged because it's not just a simple, 'Hey, let's expand Medicaid,' " he added.
Despite their acknowledgement that work will need to be done, Bell and Peterson both were pleased to see a governor going into office who will support Medicaid expansion.
The topic is critically important for the 150,000 Kansans who will receive insurance once expansion occurs, Bell said.
"It provides them a mechanism to access the system that they frankly don’t have right now," he said. "It allows them to access services that will help them to stay healthy. That is absolutely the No. 1 most important thing."
As Kansas hospitals struggle to stay financially stable in the ever-changing market, expansion also would provide support for them, Bell said. In 2016, Stormont Vail closed two area clinics, citing Medicaid cuts and failure to expand Medicaid. Two hospitals in the state have closed, and some have attributed that in part to failure to expand.
Peterson said expansion allows Kansans without health insurance access to primary care services, which may keep them from getting expensive care in emergency departments.
It's unclear how long it might take for Kansas to expand Medicaid if the Legislature takes up the issue. Bell said he would expect something to happen in the upcoming session, but even if everything went smoothly, the earliest it could probably occur would be the end of 2019. The plan would have to be approved through CMS.
"There is as process, and there's heavy lifting at any part in the process," he said.
But given that Nebraska voters approved a referendum Tuesday to expand Medicaid, joining Utah and Idaho voters who did the same, Peterson and Bell were hopeful Kansas leaders will see that as a positive.
"That should put pressure on Kansas, when we start seeing the middle of the country moving," Peterson said. "I hope we aren’t going to be the last to move."