Photo: Laura Kelly, Facebook

In Kansas, Democratic Gov. Laura Kelly and the Republican leaders of the state legislature announced today they've reached an agreement to expand Medicaid under the Affordable Care Act. It's not only honest-to-God bipartisanship, but in a genuine surprise, the more than 100,000 Kansans who'll get Medicaid coverage won't even be subjected to poor-people punishing work requirements that are all the rage in red states these days. It's a heck of a nice development, considering that expansion had been blocked by Republicans in the legislature last fall. Kelly ran on it, so of course they couldn't let it pass. Kelly's predecessor, Sam Brownback, repeatedly blocked Medicaid expansion and crashed the state's revenues through deep tax cuts that somehow never resulted in prosperity.

Now, of course, the Kansas Lege still has to actually pass the legislation, so Kansans making up to 138 percent of the federal poverty level may not want to go scheduling any "I got live-saving surgery without going bankrupt" parties yet. Still, with Republican leaders on board, it looks hopeful.


The agreement was announced this morning by Kelly and state Senate Majority Leader Jim Denning; Denning was able to round up commitments from 11 Republicans to cosponsor the legislation, and all 11 Democrats in the body are on board. That's a big deal because 21 votes are needed to pass a bill in the Senate.

"We'll be working with our respective caucuses in the coming days to get their feedback and buy-in," Denning said. "But all sides can find something in this bill to like. That means it's probably about as middle of the road as it can get."

The 10 percent of costs that the state would kick in for expanding Medicaid will be paid for through a hospital surcharge so Rs won't whine too much about taxes, and even the hospitals are in support.

Even so, as soon as the plan was announced, some Republicans started invoking fears of creeping socialism.

Senate President Susan Wagle, a Wichita Republican who is also running for U.S. Senate, invoked her status as a cancer survivor in rejecting the proposal.

She said that while no issue is more important to her than healthcare, "expanding a broken system" won't address "the one problem most Americans face."

"That is, the escalating cost of health insurance and the ever increasing out of pocket deductibles that prop up Obamacare," Wagle said in a statement. "Socialized government run healthcare is not the answer for Kansans. Healthcare reform is."

By "healthcare reform" we'll assume she means the same as wingnuts usually do: Eliminate all subsidies for healthcare and deregulate everything, and the magic of the market will make care affordable. Or you could take some responsibility for yourself and just not get sick.

The compromise also included a provision that Medicaid beneficiaries would be referred to employment resources, but not forced to meet work requirements. As we point out every damn time "work requirements come up," most Medicaid recipients ALREADY WORK. And while Republicans just looooove them some poor-shaming, work requirements often cost so much to administer that they eat up funding that could go to services. Some states throw up so many dumb hurdles -- like online registration, regardless of whether applicants have internet access -- that they keep qualified people from using the program. Which of course is the point for a lot of Rs. But not in Kansas, if the deal announced today passes.

Some Republicans may have been persuaded to support expansion because it's just about the only thing likely to prevent rural hospitals from closing, a trend that has measurably increased mortality rates in rural areas. With up to 30 percent of Kansas's rural hospitals at risk, the federal money seems like maybe a good damn idea. The plan includes the creation of an advisory panel to help protect rural hospitals in business. Free markets are fine and well, but we can see how constituents yelling at you because County General went out of business and there's no emergency room for 70 miles just might inject pragmatism into a state representative's political calculus.

So hooray for Kansas, and here's hoping this deal actually makes it into reality. If not, there should be electoral hell to pay in November.

[Kansas.com / Kaiser Health News / KWCH / ACASignups blog]

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Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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