Is it too late for Medicaid expansion in Kansas?

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"I  just hope something is changed," said Chevy Easter Thursday. He's talking about possibility of expanding Medicaid to cover some 150,000 currently uninsured Kansans, Kansans like himself who make too much to qualify for Medicaid but too little to buy their own insurance.

It could be too late, though, for Medicaid expansion in Kansas and other states that haven't already done it.  That's what some political analysts say as the Trump administration is now working to get the entire Affordable Care Act (ACA), or Obamacare, declared unconstitutional.

"It's a real chill on anyone that's looking to expand Medicaid because that's part of the Obamacare law," ABC Political Analyst Rick Klein told KAKE News.  

Since the day the ACA became law some Kansas Republicans have worried the federal government wouldn't be able to pay the 90% of the cost it promised,

"It's not a question of if they're going to drop below 90%, it's a question of when," Rep. Steve Huebert, (R) Valley Center, said last month during a debate on Medicaid expansion on the Kansas House floor.

When Medicaid expansion supporters forced that debate and vote they included a poison pill clause to end expansion if the feds don't pay up.

Supporters say expansion would insure as many as 150,000 currently uninsured Kansans, like Easter.

"Most of my money now goes to living expenses and things like that. fuel, rent and other things," he said.  "I have a budget that doesn't really involve health care right now, unfortunately."

He says those without insurance live in fear of incurring medical expenses.

"They have to go to the immediate care clinic, they're still going to walk out with a couple of hundred dollars bill that maybe you can afford it, maybe you can't," he explained.

Supporters say Medicaid expansion would also send more money to financially struggling rural hospitals and bring some $600 million in federal taxes to Kansas.

But, the president's push to eliminate the ACA all together could leave Kansas with zero federal dollars and 100% of the bill. 

"It's very disheartening," Easter said.  "It's very irritating as well.  I don't think that it should be too late."

Easter says he'd like to see the state keep working on expansion, even on its own.  Analysts like Klein say that's an option.

"Bill Barr, he was very skeptical it sounded about his own Justice Department's chances of prevailing ultimately," Klein said about the push to get the ACA declared unconstitutional.  "So I think there's a long way before any finality is there and states like Kansas are going to continue to experiment and change policies as they like."

Kansas lawmakers could choose to leave things the way they are for at least another year or expand on the hopes the federal government will pay up.  But any expansion will take a risk of leaving Kansas either with no federal money or having to cancel the expansion with little to no warning.  Two of the three options mean no coverage for Kansans currently in the Medicaid gap.

There's no timeline here, it all depends on the courts.

"I think that we should have health insurance as a population. no matter," Easter said.  "I think we should reassess where some of the money's going, if we can't afford health insurance for the population."

In a written statement, Gov. Laura Kelly's Director of Communications, Ashley All, said, "The ACA has been challenged numerous times since it became law in 2010 - and it has consistently been upheld. Not only that, there have been several rulings across the country in recent month that supported Medicaid expansion."

She then called on the Kansas Senate President to hold a debate on expansion when lawmakers return to work next month.

"It's time to stop the stall tactics. Kansans have made it clear they want to expand Medicaid. Senate leadership should listen to their constituents and allow a vote on Medicaid expansion when they return to Topeka on May 1st," All's statement said.