TOPEKA This was supposed to be the year Medicaid expansion finally happened in Kansas.
Democratic Gov. Laura Kelly, elected in November, had run on the issue. She triumphed in a state that had gone for Trump in 2016 by more than 20 percentage points and replaced a Republican governor who had vetoed a previous expansion bill.
Approximately 130,000 low-income people roughly 4.5% of the 2.9 million people in the state would be newly eligible for health insurance under the expansion, which is possible because of the federal Affordable Care Act.
But, this time around, a bill to enact Medicaid expansion never got to the Senate floor, even though the new governor and a newly empowered coalition of Democratic and moderate Republican legislators supported it.
At every turn, a handful of Republican leaders managed to block its progress, linking expansion to the welfare state and what one of them called the abomination of Obamacare.
And so Kansas remains one of the 14 states not to have expanded the health care program that helps disabled or lower-income people. It joined the ranks of Wisconsin and North Carolina, where fellow Democratic governors have not been able to overcome maneuvering by GOP-controlled legislatures to push through an expansion plan.
Theres a growing sense of impatience and anger at the fact that four legislators are stopping the will of the legislature and the governor, said Moti Rieber, head of the faith-based advocacy group Kansas Interfaith Action.
Expansion advocates will try again in 2020.
Nationwide, many state-based Republicans who once resisted Medicaid expansion are now reconsidering it as health costs have increased and the idea has grown in popularity among voters, said Adam Searing, an associate professor of practice at Georgetown Universitys Center for Children and Families.
People are getting worried about their elections, he said. The argument that This is expanding welfare to undeserving people is an argument thats losing its strength as you see health care costs going up.
Medicaid expansion has also steadily gained traction as it has been framed as a way to recoup federal tax money and stop rural hospital closures because they would deliver less uncompensated care.
In a November poll, 77% of Americans favored expanding Medicaid, according to the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)
But as support has grown, holdout politicians are deploying a new playbook like that used here to prevent the adoption of the measure: slow-walking bills, undermining grassroots ballot measures or utilizing procedural roadblocks, then adding provisions with a conservative twist that make passage unlikely.
In deep-red Utah, Idaho and Nebraska, GOP leaders either delayed or significantly changed the eye-popping Medicaid expansion ballot initiatives that voters approved in 2018.
In Missouri, the Republican governor recently created a task force to look into Medicaid expansion. Some see this as an effort to defuse energy from a brewing grassroots ballot initiative.
In Georgia, the legislature and governor have approved movement toward a partial Medicaid expansion that could include work requirements for many adults who gain coverage.
