A special committee of the Kansas Senate polished points of contention Tuesday ahead of debate on pieces of a new bill delivering health insurance coverage to as many as 130,000 Kansans through expansion of the state's $3.8 billion Medicaid program.
Political, financial and philosophical divisions among Senate Republicans that stalled a House-passed bill during the 2019 Legislature didn't dissipate, while Democrats continued to press for extension of the Affordable Care Act to working poor people unable to afford insurance. The GOP-dominated Senate Select Committee on Health Care Access will reconvene Wednesday with the goal of adopting a bill for consideration by the 2020 Legislature.
The starting point of committee discussion would be Senate Majority Leader Jim Denning's proposal featuring a $1 per pack hike in the state cigarette tax and a 5 cent per milliliter tax on vaping products. The Overland Park senator wants revenue to lower premiums for Kansas consumers buying insurance from private companies through a federal health care marketplace created under the ACA.
Denning's package would embrace the larger Medicaid footprint by assessing higher fees on Kansas hospitals, which would draw economic benefit from growth in demand for health services. Some new Medicaid participants could pay premiums toward their coverage. The bill would provide people with access to state help acquiring education or training to improve employment prospects, but it wouldn't include a mandate that recipients be employed a minimum number of hours to be eligible.
"The Senate's plan is to get a bill together that gives health care coverage to as many Kansans as we can — Medicaid and non-Medicaid," Denning said. "It has to be budget neutral to the state."
Democrats on the Senate committee urged chairman Gene Suellentrop, R-Wichita, to release a copy of Denning's 17-page bill Tuesday to all Republicans and Democrats on the panel. Suellentrop said it was a "working document" and he wasn't eager to share details of the GOP-crafted bill. He later promised to release a copy of the bill Tuesday night to the senators.
Tom Bell, president of the Kansas Hospital Association and an advocate of Medicaid expansion, said the Senate discussion about details shaping an expansion bill represented progress beyond previous informal feuding about whether to expand.
"I want to thank you for the discussion and argument," Bell said.
Both the tax hike and exclusion of a work requirement in Denning's proposal served as red flags for conservatives deeply skeptical of Medicaid expansion.
Sen. Ty Masterson, R-Andover and a member of the special Senate committee, said Medicaid reform could benefit the uninsured and hospitals, but not all his constituents would reap rewards.
"What about that commercial payer who might have his costs go up? Does it help that guy?" Masterson said. "We often talk in politics, right, we get excited about who is the victim. I'm not convinced yet the victim is that able-bodied person without insurance."
Sen. Molly Baumgardner, a Louisburg Republican on the Senate panel, said it could be difficult for a single mother to abide by a Medicaid work mandate through a 20- to 30-hour per week job and secure resources to deliver quality day care for her children.
"There are certain circumstances when it's not necessarily appropriate for them to be working," she said.
Democratic Gov. Laura Kelly, a former Topeka senator, campaigned in 2018 on a pledge to achieve Medicaid expansion after GOP Govs. Sam Brownback and Jeff Colyer successfully opposed deepening reach of the program to economically disadvantaged Kansans.
Medicaid in Kansas covers 340,000 disabled, elderly and low-income Kansas residents. Adults with children must have an income below the federal poverty level to be eligible for Medicaid.
If expansion would occur in Kansas as it has in other states, the federal government would pay 90% of expansion costs with Kansans picking up 10%. Under the state's existing Medicaid program, called KanCare, the federal government covers 55% of health costs and the state pays 45%.