Medicaid expansion hearing fuels heated debate; House plans to work bill

TOPEKA (KSNT) - Kansas lawmakers are taking up Medicaid expansion at the statehouse for the first time in four years. People from across the state packed committee rooms, lining up to discuss the issue on Wednesday.

"I need your help filling the gap," said Erica Christie, who testified as a proponent on behalf of the Center for Independent Living.

Christie said her group works with people with all disabilities, regardless of age or income. She testified as a proponent of Democratic Gov. Laura Kelly's plan to expand Medicaid to 150,000 Kansans in the coverage gap.

"I can't quit my job. I can't go to the doctor, and I can't get Medicaid. That's that gap triangle we talk about when we talk with consumers," Christie said.

Kelly kicked off the legislative session with the introduction of her Medicaid expansion proposals in the House and Senate.

The Senate Ways and Means Committee held an informational hearing on the bill Wednesday morning. Meanwhile, the House Health Committee scheduled a hearing on the governor's House bill.

The governor's proposal would also include work requirements, as an attempt to address concerns from some Republicans about people taking advantage of the system.

Opponents of the bill argued that Medicaid expansion would mainly cover "able-bodied" adults.

"It's a non-disabled, non-elderly adult of a certain age. By federal law that person in other welfare programs is called, in law, an able-bodied adult," said Sam Adolphsen, Visiting Fellow with the Opportunity Solutions Project, a non-profit policy organization based in Florida.

Adolphsen, along with other opponents, also raised concerns about the cost of expanding Medicaid. They worry that the state would be "on the hook" for millions of dollars, which is expected to come down from the federal government if Kansas moves forward with expansion.

"The cost will turn out to be higher than even the highest official projection during the debate," said Dean Clancy, with Americans for Prosperity, a "Libertarian conservative" political advocacy group.

Currently, states are incentivized to expand Medicaid with the promise of a 90% matching rate for the expansion population.

"Kansas cannot count on the federal contribution remaining at 90 percent," Clancy explained in his testimony. "It is going to go down, probably to a blended rate well south of 90 percent. Eventually, I would expect, it will go down to the regular Medicaid matching rate."

However, some supporters argued that expanding Medicaid could be another "tool" to tackle the state's rural hospital crisis.

"I saw the grim reality of uncompensated emergency care for uninsured Kansans drive up the cost of healthcare for insured Kansans," said Benjamin Anderson, Hutchinson Regional Healthcare System President and CEO.

Anderson said he didn’t support Medicaid expansion until working at a rural hospital himself. He recounted his experience, where he said he witnessed the impact lack of coverage can have on rural hospitals.

"During these 11 years, I saw the grim reality of uncompensated emergency care for uninsured Kansans drive up the cost of health care for insured Kansans," he said. "That trend was leading to increases in write offs associated with high-deductible plans. Each year, our hospital had to scrap together the money to stay open. Around that time, we started to see financially distressed rural Kansas hospitals close their doors. This dynamic still exists today."

The state has pointed to data from the Center for Healthcare Quality and Payment Reform, a national policy institute. According to their report, as of July last year, 58% of Kansas’ rural hospitals were at risk of closing, and nearly 83% lost money on patient care.

As for whether the House bill will move forward, it will be up to the Republican chair of the House Health Committee to kick off efforts to get it to the floor.

Nexstar's Kansas Capitol Bureau spoke with Rep. Brenda Landwehr, (R) Wichita, about whether she plans on working the bill. She said they could start working it in committee as soon as Thursday.

"It's the committee that decides whether to move it to the floor, so we'll plan to work it," Landwehr said.