Joe Biden's COVID-19 relief bill could give Kansas an extra $450M ― if it expands Medicaid

Kansas remains one of 12 states to not adopt provisions of the Affordable Care Act, which would expand Medicaid to at least 130,000 to 160,000 low-income people.  

But Congress is expected to pass its next COVID-19 relief package Wednesday, and national Democrats have tucked in a section aimed at enticing states that haven't expanded Medicaid to do so.

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Under the proposal, Kansas would get a temporary increase in federal match funding of five percentage points for two years for current enrollees, if it expands Medicaid. Currently, states that have expanded receive a 90% federal matching rate for those covered under expansion.

"We need to build on the progress of the Affordable Care Act, not tear it down in the middle of a global pandemic," U.S. Rep. Sharice Davids, D-Kan., had said when pushing similar Medicaid-incentivizing legislation last year.

According to estimates from the Kaiser Family Foundation, the incentive would lead to an additional $450 million in federal funding for Kansas. That boost could well cover the projected cost of expansion over two years, about $210 million, leaving a net plus of $250 million.

More:Gov. Kelly wants to use medical marijuana funds for Medicaid expansion in Kansas

The high cost of expansion is a major reason Republicans who dominate the state Legislature have opposed it. Democratic Gov. Laura Kelly sought to address that concern earlier this year, signaling she wanted to pay for expansion by using funds from legalizing medical marijuana. 

But Kelly's proposal and this one are unlikely to change things, as state GOP leaders thus far have refused to bring up for hearing any Medicaid expansion-related bills this legislative session.

"I'm glad to see the other side finally drop the narrative that 'Hey, it's not going to cost anything,' " said state Sen. Richard Hilderbrand, R-Galena, on the Kansas Senate floor after a Democrat tried to amend a bill last week by adding Medicaid expansion.

Last week was the first, and perhaps only, time the issue was formally debated by the Legislature this year.

Republicans also pointed to other talking points during floor debate, such as expansion allowing for taxpayer-funded abortion or that it would force people off their private plans. 

The lawmaker who brought up that amendment, Kansas Senate Minority Leader Dinah Sykes, D-Lenexa, shot back at the GOP.

"If their true concern with expansion is its cost, then this is a no-brainer for Republican leadership to get on board," she said. "I suspect that now this concern has been addressed, they’ll find another reason to keep affordable health care out of reach for as many as 165,000 Kansans during the worst public health crisis in a generation."

Advocates for expansion say it would help hospitals, create jobs, increase the number of insured people and not leave money belonging to Kansans on the table.

A spokesperson for Senate President Ty Masterson, R-Andover, implied the party's position hasn't changed with knowledge of the relief bill's incentives. The state's legislative session is already past its halfway point. 

"Expanding Medicaid to include able-bodied adults would force tens of thousands of Kansans off their insurance and further destroy the private market, which has already been damaged by Obamacare," Masterson said. "The best way to improve access to health care is to create more choices for Kansans by removing barriers to competition and removing the regulations that drive up the cost of health care."

Ultimately, it is a dynamic playing out not just in Kansas but in other red states across the nation.

The COVID-19 relief package will not be enough of an inducement “for conservative politicians reluctant to be seen as getting in bed with Obamacare,” said Greg Shaw, a political science professor at Illinois Wesleyan University, to USA TODAY. “It’s because of the political optics.”