The Senate's top Democrat urged lawmakers of both political parties Thursday to support a mildly altered version of the bipartisan Medicaid expansion bill approved by the House and endorsed by Gov. Laura Kelly, setting up a clash with GOP senators championing a more complex third alternative.

Republican leaders in the Senate blocked votes on the House bill during the 2019 session, but appear willing to debate in 2020 a bill opening eligibility for the government health insurance program for 130,000 to 150,000 working-class, modest-income Kansans.

In anticipation of a big political fight in January, Senate Majority Leader Jim Denning, R-Overland Park, in October unveiled a distinct alternative to the House-passed bill. It was advanced by a special Senate committee at Denning's urging, but subsequently received a lukewarm reception from a GOP-led interim Medicaid committee comprised of senators and representatives.

"It's important to give senators the opportunity to co-sponsor a straightforward Medicaid expansion bill," said Senate Minority Leader Anthony Hensley, D-Topeka. "Senator Denning's bill is unnecessarily complicated and expensive."

Denning's blueprint inspired controversy, in part, because it raised tobacco taxes to subsidize private insurance rates of people outside Medicaid. Missing was a favorite idea of conservatives to require employment for able-bodied adults added to Medicaid. His bill would mandate Kansas first seek federal permission for partial expansion of Medicaid, an idea viewed as futile by Democrats.

"I don’t follow the Democrats talking points about the draft Senate plan being too complex," Denning said. "It is straightforward, in fact, I usually explain it visually with my grandchildren’s building blocks."

Hensley said Denning's idea of imposing a tax to create subsidies for insurance premiums should be considered separately from a basic Medicaid expansion bill.

Under Hensley's proposal to merely tweak the House bill, new participants under expanded Medicaid would pay a monthly fee up to $25. The House offered a fixed $25 fee each month. Hensley's amendments would allow Kansas Department of Health and Environment to grant hardship exemptions to the fee. In addition, Hensley would delete from the House bill a provision locking out of Medicaid anyone who missed premium payments.

"The House passed a good Medicaid expansion bill. I am pleased the Senate is looking to introduce a bill similar to what the House passed," said House Minority Leader Tom Sawyer, D-Wichita.

More than 350,000 poor, disabled or elderly people in Kansas are enrolled in the state's $3.8 billion Medicaid program known as KanCare.

Kansas would be the 37th state to enhance eligibility for Medicaid since the Affordable Care Act was initiated five years ago. The federal government is required to pay 90% of the cost of expanding a state's enrollment in Medicaid under ACA.

Denning said his proposal would be revenue-neutral because it included a $50 million tobacco tax, a $31 million surcharge on hospitals and $63 million in fees to managed-care insurance companies supervising Medicaid clients.

"It would also be very productive for the governor to sit down and discuss the draft Senate bill with our office in order to see how we can move this policy forward in a bipartisan fashion and do what is best for Kansans," Denning said.

Kelly, a Democratic, has made Medicaid expansion a top priority. She said the Legislature ought to act on an effective and sustainable plan that avoided red tape, higher taxes and taller hurdles to accessing health care.

Larry Campbell, budget director for Kelly, came under fire last week at a legislative hearing when asked about expansion of Medicaid. Several GOP lawmakers indicated Campbell was playing partisan politics with his analysis of options.

Campbell said the House bill would cost the state $34 million annually and bring more than $1 billion each year in federal funding for health care. He said Kansas' reluctance to expand left $3.7 billion in federal funding for Medicaid on the table in Washington, D.C.

"You know and I know there's a recession coming," said Rep. Brenda Landwehr, a Wichita Republican opposed to changing Medicaid eligibility. "Will Kansas be able to sustain this program? That's one of the things we're trying to figure out."