The largest Catholic dioceses in Kansas conditioned political support Wednesday for legislation expanding Medicaid health insurance to 130,000 low-income adults and children on passage of a constitutional amendment and new state law curtailing abortion services.

A House and Senate committee wrapped up two days of hearings at the Capitol centered on details of broadening eligibility for KanCare beyond about 400,000 people with disabilities, pregnant women, the elderly and poor enrolled in Medicaid.

Rep. Brenda Landwehr, the Wichita Republican who chairs the joint committee, said lawmakers on the panel shouldn't recommend an expansion bill to the 2020 Legislature.

"We are not advancing a bill forward out of this committee," Landwehr said. "We are not recommending passage of the bill."

During the 2019 session, the GOP-led House adopt an expansion bill quickly shelved by the Senate. A special Senate committee in October endorsed an alternative developed by Senate Majority Leader Jim Denning of Overland Park.

Chuck Weber, executive director of the Kansas Catholic Conference, told the joint House and Senate committee the organization's support for any expansion legislation was contingent on passage of a statute explicitly blocking use of Medicaid to enhance abortion services. It also would be linked to passage of a law granting medical professionals or health facilities an opportunity to invoke religious conscience objections to certain procedures.

Weber said there would be no backing of Medicaid expansion by Catholic dioceses in Dodge City, Salina, Wichita and Kansas City, Kan., without adoption of an amendment to the Kansas Constitution eliminating the "natural right" to abortion affirmed in a recent decision by the Kansas Supreme Court.

"The Catholic desire of authentic affordable health care for all people, regardless of socioeconomic status, is inspired by the example of Jesus, the great physician," Weber said.

The House-Senate committee approved a motion by Rep. Will Carpenter, R-El Dorado, prohibiting expansion of Medicaid from broadening access to abortion and to enable health providers to decline to provide patient care, such as birth control, based on personal beliefs.

"You don't care about religious beliefs of patients?" said Sen. Barbara Bollier, a Mission Hills Republican running for the U.S. Senate.

"I'm not concerned with that," Carpenter said.

Lee Norman, a physician and secretary of the Kansas Department of Heath and Environment, said establishing a religious exemption in Kansas could be "perilous" if, for example, an emergency room physician declined to treat a patient who encountered complications from use of birth control. Norman said layering Medicaid with ethical boundaries could make it difficult to build a robust network of providers.

The joint House-Senate committee also voted to insert in Medicaid expansion bills requirements that able-bodied adults added to KanCare be required to work at least 20 hours per week or enroll in 12 credit hours of college courses in order to be eligible. The federal government has approved work mandates for other states, said GOP Sen. Gene Suellentrop, but all have been blocked by the courts.

Gov. Laura Kelly, a Democrat who took office in January, has made passage of expansion legislation one of her top priorities in the upcoming 2020 session. Since implementation of the Affordable Care Act, 36 states and the District of Columbia approved of extending eligibility for Medicaid to low-income residents. Govs. Sam Brownback and Jeff Colyer successfully blocked expansion by the GOP-led Legislature.

April Holman, executive director of the Alliance for a Health Kansas, said the state's largest coalition supporting Medicaid expansion had sought since 2016 to close a health insurance coverage gap between people who make too much money to qualify for Medicaid and not enough to receive subsidies to buy private health insurance.

She said both the House bill and Senate committee proposal required low-wage people signing up under Kansas' expanded Medicaid system to pay monthly insurance premiums that could be difficult to afford.

"Premiums create a barrier to participation," Holman said. "Budgets for families living in poverty and even those slightly above the poverty line are unbelievable tight."

She questioned a provision in the House bill permanently locking out of Medicaid an individual missing three premium payments and the Senate committee's preference to lock people out for six months if a premium payment was missed.