TOPEKA — Lawmakers effectively killed a bill expanding Medicaid on Monday, crushing proponents who had hoped the new, more moderate Legislature could advance their cause after years of stymied efforts at the hands of conservative Republicans.
The House Health and Human Services Committee voted 9-8 to delay debate on the bill until April 3. But because of legislative rules governing committee work, the vote essentially eliminated the possibility of further debate this year, without intervention by the House speaker or a super-majority vote of the House — both of which appear unlikely.
“It’s dead,” said the committee chairman, Rep. Dan Hawkins, a Wichita Republican who opposes expansion.
A new contingent of moderate Republican and Democratic lawmakers backing expansion had raised the hopes of supporters. Some believe expansion could pass the House if put up to a vote.
But President Donald Trump’s White House victory and the ascendance of congressional Republicans determined to repeal the Affordable Care Act has scrambled the Medicaid expansion discussion in Kansas and other states. Expansion opponents argue it soon will be a thing of the past, while supporters say expansion would put Kansas in a better position if the federal government converts Medicaid into a block-grant program.
“I think this is a failed opportunity to do what’s right for Kansas and vote to allow the full House to have a debate about how expanding KanCare can improve access to health care, create jobs and protect hospitals,” said David Jordan, director of the pro-expansion group Alliance for Healthy Kansas.
Rep. John Wilson, D-Lawrence, said lawmakers had the chance to help a group of Kansans “desperate for something.”
The outcome of the committee debate had appeared in doubt ahead of Monday’s meeting. The panel appeared closely split, and an early motion to table the bill until 2018 failed in a tie vote.
The legislator who proposed putting off consideration of the bill until April, Rep. John Barker, said an anticipated decision from the Kansas Supreme Court over school funding was an “elephant in the room.” The court’s decision could require $300 million to 500 million in additional spending, the Abilene Republican said.
Gov. Sam Brownback has said expansion would cost Kansas more than $100 million in the next two years. But it also would bring in hundreds of millions in federal funds, and some supporters say it would generate revenue for the state.
Expansion proponents also focused on the potential to provide an influx of resources into rural hospitals, which are struggling throughout the state. A hospital in Independence closed in 2015.
“Many of these hospitals are barely hanging on,” Rep. John Eplee, R-Atchison, said. “The impact it’s going to have in these communities are going to be devastating.”
Although hearings on expansion drew more than 100 supporters and relatively few opponents, the legislation faced long odds to becoming law. Even if it had passed the House, it also would have had to pass the Senate and would have almost certainly been vetoed by Brownback.
Brownback has said expansion “moves able-bodied adults to the front of the line, ahead of truly vulnerable Kansans.” His office previously has cited waiting lists for services for people with disabilities in opposing expansion, an argument rejected by organizations representing people with disabilities.
Speaking after the hearing, Rep. Randy Powell, R-Olathe, said the move to table the bill “makes a lot of sense because we have to look at a bigger picture” financially.
A significant sticking point during hearings on the bill was the potential expenditures versus savings to the state.
Initial cost projections by the Division of Budget pegged the overall cost to the state at more than $100 million for two years, but the Kansas Hospital Association and Beloit Republican Susan Concannon raised questions about the accuracy of that amount.
Last week, Concannon raised concerns again that the state, despite having reviewed and revised its projections, still was excluding from its calculations potential revenue related to the bill.
“If the fiscal note is going to be reflective of the bill we are working, it’s got to show the savings,” Concannon said.