Gov. Sam Brownback of Kansas vetoed a bill on Thursday that would have expanded Medicaid in his state, setting up a potential showdown next week with a Legislature that, while heavily Republican, has come to favor extending the largely free health coverage to as many as 180,000 additional poor adults.
Although the bill was easily approved in both chambers of the Legislature, supporters would need to muster three additional votes in the House and two in the Senate to override the veto by Mr. Brownback, a conservative Republican.
After the House briefly debated an override on Thursday, the measure was put aside, probably until at least next week. Supporters were hoping to mobilize hundreds of residents who would benefit from Medicaid expansion, as well as hospital executives, clergy members and others who back the measure, to lobby specific lawmakers over the weekend.
“Our plan is to make sure their phones are ringing off the hook,” said David Jordan, executive director of Alliance for a Healthy Kansas, an advocacy group.
Republican lawmakers in Kansas were initially solidly opposed to expanding Medicaid under the Affordable Care Act, commonly known as Obamacare. But many softened their positions over the last year or so, particularly influenced by the financial struggles of the state’s small rural hospitals. Momentum grew after several Democrats and moderate Republicans picked up legislative seats in the elections last fall, although the leaders of both legislative chambers remain opposed to any expansion.
In his veto message, Mr. Brownback said the cost of expanding Medicaid would be “irresponsible and unsustainable,” citing other states where Medicaid enrollment grew far more than expected after they expanded the program. The expansion effort comes in the midst of a budget crisis that has roiled Kansas for years.
Passage of the Medicaid bill was another sign of revolt against Mr. Brownback, whose tax-cutting regimen led to years of missed revenue forecasts and budget cuts. Last month, House lawmakers voted to override Mr. Brownback’s veto of a bill that would have raised taxes, but the Senate upheld the veto.
Lawmakers face projected budget deficits of more than $280 million for the current fiscal year and more than $510 million for the next year. They also must address a recent state Supreme Court ruling that found public school funding to be unconstitutionally low.
In emotional debate on Thursday, less than a week after President Trump and Republicans in Congress pulled legislation to repeal the Affordable Care Act, Kansas House members who support Medicaid expansion framed the issue as a moral imperative that could save lives and stave off hospital closings in beleaguered towns.
“I am appalled with the letter that was read from the governor,” Representative Larry Hibbard, a Republican, said on the House floor, referring to Mr. Brownback’s veto message. Mr. Hibbard said he worried that some rural hospitals in his district in southeastern Kansas could close without Medicaid expansion, hurting patients and imperiling the future of those towns.
“The lack of compassion toward this issue just blows my mind,” Mr. Hibbard said. “This is a life-and-death issue.”
Opponents often cited concerns about the state’s broader budget challenges.
Representative Chuck Weber, a Republican from Wichita, said expanding Medicaid would make it harder for those already covered by the program to receive care.
Another Republican, Representative Daniel Hawkins of Wichita, noted the uncertainty surrounding the Affordable Care Act, a concern also raised by Mr. Brownback.
Under the Affordable Care Act, the federal government currently pays 95 percent of the costs of expanding Medicaid, eventually dropping to 90 percent but never less. But the Republican repeal bill would have made it all but impossible for states to keep that large federal match.
All but 19 states have expanded Medicaid to cover adults with incomes up to 138 percent of the poverty level — $16,400 for a single person. Voters in Maine will decide whether to do so in a ballot referendum this fall, and Democrats in a few other states are renewing pushes to expand the program now that the Republican plan to repeal the health law has been stalled.
But at the same time, some Republican governors are discussing adding work requirements for their Medicaid populations or even scaling back enrollment now that the Trump administration has promised states more flexibility in determining benefits and eligibility.
“The next hospital to fail could be in your community or your district,” said one supporter of the expansion, Representative Jim Kelly, a Republican from Independence, where the only hospital closed in 2015. “And I will tell you from experience, real-life experience: It’s not a pretty picture.”
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