Legislative maneuvering in Kansas will likely postpone a decision on Medicaid expansion, if the state ever decides to enter the program.
Gov. Sam Brownback (R), a leading Obamacare opponent, has punted the decision to the Republican-controlled state legislature, which has largely kept the topic under study during a legislative session dominated by the topics of taxes, abortion and guns. With lawmakers reconvening this week, it appears likely that the legislature will further delay a decision on expanding Medicaid by requiring any such expansion be approved by lawmakers.
Brownback is one of three governors not to take a definitive postion on Medicaid. South Dakota Gov. Dennis Daugaard (R) said he is against the expansion but has formed a commission to study it, and Kentucky Gov. Steve Beshear (D) spoke favorably on the expansion but did not endorse it.
"In the short term, I don't see anything happening," state House Social Services Budget Committee Chairman Brian Weber (R-Dodge City) told The Huffington Post. "A lot of people are gathering information and looking for what other states do. That is the mode Kansas will be in for a period of time."
The main issue under consideration for Weber and others is the fiscal impact on the state and the federal government. Weber said Republicans in the House want to know what happens if the federal government decides down the line to decrease funding to less than 90 percent. He also said Kansas lawmakers want to know whether the state would be given the option to leave the expansion, along with concerns about federal budget solvency. Weber said he wants to study the Arkansas model, which included privatizing the program and providing insurance through a health care exchange.
State lawmakers estimate that an expansion in Kansas would add 200,000 of its residents to Medicaid rolls. The state expansion would be fully federally funded (at $385 million a year) for the next three years, after which the state would pick up 10 percent of the costs. Full federal funding is only available until 2016, so states that delay stand to miss out on those savings.
The Republican-controlled state Senate has already passed a budget amendment that would require any expansion to be approved by the legislature. Senate and House leaders have been meeting in conference committee to hammer out a final version of the budget with the amendment expected to remain.
State Rep. Jim Ward (D-Wichita), the chief Democrat on the House Health and Human Services Committee, told HuffPost that lawmakers should act now and approve the expansion. He said he believes that Brownback has remained silent so he can later say that the legislature tied his hands by preventing him from making a decision without them.
Brownback's spokeswoman did not return a request for comment.
Ward also questioned why Republicans are concerned about the impact on the federal budget, noting that Brownback and lawmakers have been actively seeking hundreds of millions in federal funds to build a new homeland security research center at Kansas State University, which has been touted as an economic development project. Ward said that all the delay will do is help non-Kansans.
"If we don't take the money, it won't got to deficit reduction, the $385 million will go to other states," Ward said. "It will go to health care in other states."
Republicans are not united, however, with state Rep. Barbara Bollier (R-Mission Hills), a retired physician, pushing for the expansion. She disagreed with Weber's apprehension about what would happen in the event the federal government decreased funding, noting that the state can always opt out. She said that, nationally, Republicans should have addressed health care long ago.
"The U.S. has wanted change over the last 10 to 15 years. The Republicans were in control and did nothing to change things," she said. "The country elected a president on the notion of change."
Opposition to Obama's health care law has played a central role in GOP campaigns, particularly in Kansas, where Americans for Prosperity, the Koch brothers group, looms over local politics. Many Democrats and moderate Republicans were targeted with mail pieces from the group saying they "opened the door to Obamacare in Kansas."
Weber said that opposition to the Affordable Care Act is not a factor.
"I think the solvency of the federal government is a variable," he said. "As far as the expansion and the ACA? Not so much."
Bollier said she still isn't sure why her GOP colleagues have not approved the expansion.
"I have yet to figure out what motivates them on this," she said. "When I say 'them,' I mean the majority and the administration."
Jeffrey Young contributed to this report.