Medicaid Expansion Compromise

We may have mentioned once or twice that Medicaid expansion will be a big topic in this year's Kansas Legislature. As it was last year. And the year it actually passed, only to be vetoed by Gov. Brownback, then failing to overturn the veto by one vote in the Kansas Senate. And for years before that, too. Well, we have reason to believe this might be the year it gets done.

Last week, Gov. Laura Kelly (D), and Sen. Jim Denning (R) announced they had reached a compromise, and would introduce a bill to be considered this session. That bill has now been filed, SB252, "Expanding medical assistance eligibility and implementing a health insurance plan reinsurance program."

The bill is complex, because health insurance is complex. We've consulted with our partners in health care advocacy, and here is what you need to know.

The bill

If passed as written, SB252 would implement Medicaid expansion to start next year, January 1, 2021. It would expand the people eligible for coverage to 138% of poverty, the Federal standard. That would allow the 150,000 working Kansans who right now fall in the coverage gap to gain access to affordable health care.

It includes a premium of "up to $25" per month for individuals enrolled, though a sliding scale and hardship assistance is included. It does not include a work requirement, but does include a work referral program, which would work with enrollees to determine if they should be connected to the State's KansasWorks jobs program. Finally, it does not include lockouts, meaning if an enrolled person is unable to pay the premium, they are not barred from the program. Instead, they will incur debt, and have access to a debt setoff program, but will not lose coverage.

The bill has a second set of policy proposals, involving a reinsurance program, with implementation to happen by January 1, 2022. In brief, this would allow reinsurers to work with health insurance companies to bring down costs, and lower costs to consumers.

The compromise

Gov. Kelly held meetings this fall with her council on health care expansion, to study and come up with policy solutions. Sen. Denning held hearings and discussions, too, with a Legislative committee. As the Legislative Session approached, they worked together to craft something they could bring forward.

The result has some compromises for both sides. A premium, meaning a fee to be enrolled, is a barrier to access. But the premium included in the bill contains a sliding scale, and assistance for those unable to pay. Lockouts—throwing enrollees off the program and preventing re-enrollment for a period of time if they cannot pay—are not included in the bill, and that is a win. Nobody would be thrown off health care, and kept off, if they are unable to pay. A work requirement dictating that enrollees be working at a job is another common barrier to access, and is not included in this bill. Instead, the work referral program helps people who need it.

On the topic of work requirements, truth is, of the 150,000 people who would become eligible, most are already working, others are caregivers at home, and still others are unable to work due to illness or disability. Only about 6% of them are able to work and are not employed. The bill will encourage those Kansans to find work, and offer assistance in doing so.

The myth that there are an enormous number of lazy, lay about adults who are living off the government is just that, a myth. Work requirements are extremely expensive to administer for state governments, especially given the small number of people affected, and many states are reconsidering or delaying their work requirement provisions. (Center on Budget and Policy Priorities)

The reinsurance program, which would pass with expansion, is independent from a policy standpoint. Its potential effect in Kansas is unclear, given our historical trend of steady insurance pricing. As written, the success of expansion is not tied to the success of the reinsurance program.

How it happened

Alliance for a Healthy Kansas logo

We need to thank the people who have gotten us to this point. A decade of activism and advocacy has ensured the issue has never been swept aside. The Alliance for a Healthy Kansas, a coalition of which Mainstream is part, has worked tirelessly, even when faced with near certain defeat, to keep the issue alive, and to keep Kansans and their elected officials educated. Thank you to all the advocates.

When she was campaigning, Gov. Kelly promised to fight for Medicaid expansion. Last year she did so, and this year she is doing so again. She is experienced, caring, and relentless, a good combination for someone on your side. We appreciate her support of Kansans who need access to health care.

Sen. Denning, it must be said, deserves some thanks. Without him reaching out to the Governor, this compromise bill would not exist. In the 2019 Legislative Session, an expansion bill nearly passed, but was prevented from receiving a floor vote in the Senate by that chamber's Leadership. But this year, there was a very different feeling in the air, as the question shifted from "Should we pass expansion?" to "How do we pass expansion?"  SB252 has 22 co-sponsors in the Kansas Senate, and each of them are ready to pass this bill.

The path ahead for SB252 is going to be interesting.

The politics

We pride ourselves at Mainstream for explaining the nuance of politics. This effort certainly has some nuance that is worth noting. First, as mentioned above, the question seems to have shifted from why expand, to how to expand. What is behind that? It may be the popularity of expansion among Kansans (polls indicate two thirds favor it) and the upcoming 2020 election (remember, it's not just a Presidential election, every Kansas legislator is up for re-election this year).

The shift by Senator Denning is also striking. When expansion failed last year, it was Sen. Denning's vote that kept it from happening. Now, he is spearheading this compromise bill. The reinsurance piece is important to him, his constituents favor expansion, and he faces re-election this year. Whatever the reasons, we appreciate his support of those 150,000 working Kansans who would receive access.

While support for expansion has always been present in the House and Senate in Topeka, Leadership of those chambers has remained steadfastly against it. Sen. President Susan Wagle (R) has consistently opposed it. In the aftermath of SB252, she has made a few statements that indicate she remains opposed. We would, of course, appreciate her support for extending access to health care to the 150,000 working Kansans who need it.

The next few weeks should bring some clarity. Stick with us and we will keep you informed.

Do more than vote in 2020.

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