TOPEKA, Kan. (AP) — Gov. Sam Brownback's allies have raised the potential expansion of the state's Medicaid program as a campaign issue in the days before Tuesday's election decides races for the Kansas Legislature, with conservative Republicans seeking to bind Democrats to President Barack Obama and the federal health care overhaul.
The federal law enacted in 2010 contemplates an expansion of Medicaid to cover millions of uninsured Americans, and it promises that the federal government will pick up the full cost until 2016 and most of it afterward. A U.S. Supreme Court's decision in June said states could refuse to expand their programs, which provide health coverage for the poor, the disabled and elderly.
Many Kansas Republicans are skeptical of the funding promises, noting the federal government's ongoing budget problems. Officials assume Brownback will declare after the election whether Kansas will opt in or out of the expansion, but retiring House Speaker Mike O'Neal, a conservative Hutchinson Republican who's also chief executive officer of the powerful Kansas Chamber of Commerce, said last week that voters need to know whether legislators and candidates would support an expansion.
The chamber already has attacked Democrats for opposing a proposed health care "freedom" provision for the state constitution, protesting the federal law's mandate that most Americans buy health insurance starting in 2014. O'Neal issued his statements as Democrats were pointing out that the measure was largely symbolic, countering the chamber's assertions in mailings that the proposal would "stop the Obama agenda at the Kansas border."
But the Medicaid issue also ties into long-standing Republican themes portraying Democrats as advocates of big government. A report in July from the nonpartisan Kaiser Family Foundation said an expansion would cover nearly 264,000 adults in Kansas — where 393,000 residents now receive health coverage through the state.
"The simple fact is, we can't afford it," said House Majority Leader Arlen Siegfreid, a conservative Olathe Republican, adding that if Obama is re-elected, "We're going to be watching that very closely."
Democrats aren't openly embracing a Medicaid expansion, even if they believe it would reduce the number of uninsured Kansans. They contend the state can't seriously contemplate any additional spending because of massive income tax cuts enacted this year.
Kansas Democratic Party Chairwoman Joan Wagnon said any discussion of expanding Medicaid was "rendered moot" when Brownback signed the tax cuts in May. Legislative researchers estimate that the cuts are worth $4.5 billion over the next six years and project that the reductions — meant to stimulate the economy — will produce collective budget shortfalls approaching $2.5 billion during the same period.
"He's dug a hole as big as the Grand Canyon in the budget," Wagnon said.
Republicans enter the election with majorities of 32-8 in the Senate and 92-33. However, the Senate's leaders have been GOP moderates, and they've worked with even liberal Democrats since Brownback took office in January 2011 to stall some of the conservative governor's agenda. Conservatives ousted eight moderate GOP senators in the August primary, making it possible for the GOP right to control both chambers, particularly if Republicans retain or expand their majorities.
Democrats have positioned themselves as the last check on Brownback's agenda. The chamber and other Brownback allies have made Obama a key issue — a tactic that worked well both in 2010 and this year's primaries.
Brownback has been critical of the federal health care overhaul, and he faces key decisions about whether the state will expand Medicaid and have a role in an online health insurance marketplace contemplated by the law.
He acknowledged he's worried about the potential cost of expanding Medicaid but said, "We're not going to be doing anything prior to the election."
The federal health care law says that in 2017, states would pick up 5 percent of the cost of the Medicaid expansion, with the figure growing to 10 percent by 2020. In the past, states generally have been required to pick up about 40 percent of the cost, and in Kansas, the state's share for its $2.9 billion-a-year program is almost $1.2 billion.
Some state officials also worry that Kansas could face substantial new costs if it agrees to the Medicaid expansion because people who are now eligible without the expansion but not participating in the program also could seek coverage, an issue noted by a Congressional Budget Office report in July.
Joshua Powell, a part-owner of small web-design and media businesses who's running for the Kansas House in a north Topeka district as a conservative Republican, said the federal health care law is unpopular because people "just don't want Washington messing with their health care." He said voters aren't focusing on the Medicaid expansion, but he's wary.
"Does the federal government have the money for it?" he said. "I mean, we're running pretty big deficits right now."
Powell's opponent, Democratic state Rep. Sean Gatewood, is alternately frustrated and semi-amused by attempts to tie him to Obama, someone he's not met. Gatewood said he'd place a higher priority on eliminating the state's waiting lists for disabled residents seeking in-home services than expanding Medicaid, but he sees neither as possible because of the income tax cuts.
"It's all irrelevant," Gatewood said.
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