TOPEKA, Kan. (AP) -- Kansas will hurt hospitals and poor residents if it doesn't expand Medicaid as encouraged by the federal government's health care overhaul, state Insurance Commissioner Sandy Praeger said Tuesday.

Praeger's support for the expansion is another example of how the GOP commissioner is at odds with other Republicans over the 2010 federal health care law championed by President Barack Obama. Praeger, a moderate Republican, has praised the law as an important step toward ensuring universal access to health care, while many GOP conservatives, including Gov. Sam Brownback, are strong critics.

The Topeka Capital-Journal reported (http://bit.ly/15vYSWC ) that Praeger said the state will be "leaving money on the table" if it doesn't expand Medicaid, which provides health care for the needy and disabled. The federal government has promised to pay for almost all of the expansion.

While Praeger has long been on record praising the federal law for broadening access to health care, she expanded her argument for the legislation Tuesday, saying hospitals in Kansas will take a financial hit if the state doesn't expand Medicaid. That's because the law reduces subsidies to care for uninsured patients -- presuming that more of them will have coverage -- and rural hospitals will be especially vulnerable, she said.

She said the Medicaid expansion likely would cover about 240,000 of the 365,000 uninsured Kansans. Otherwise, many poor residents will continue to rely on overburdened hospital emergency rooms for care, Praeger said.

"That is a group that is probably not getting the care they need," Praeger said. "We know they're not."

A resolution expressing opposition to expanding Medicaid is before the Kansas House, and many Republican legislators are skeptical that the federal government will keep its funding promises.

Brownback hasn't taken a position, saying he will leave it to the Legislature. But his administration commissioned a recent study saying the expansion would cost the state $600 million over the next 10 years.

The Kansas Hospital Association also commissioned a study, which showed the expansion would be a small, net financial gain for the state.