Will Expanding Medicaid Save Sam Brownback?

Today’s most “>startling story, from TPM’s Daniel Strauss, is about the growing signs Kansas–yes, Kansas–may be moving crabwise towards a deal to expand Medicaid in order to solve the fiscal crisis created by Gov. Sam Brownback’s enthusiasm for tax cuts.

Brownback, who had previously expressed strong opposition to Obamacare, signaled Wednesday he wasn’t totally opposed to a Medicaid expansion.

“I haven’t said we’ll take it. I haven’t said we wouldn’t,” Brownback said according the Lawrence Journal-World. “Last year, I signed the bill that the Legislature passed [saying] that the Legislature had to approve any Medicaid expansion. I think that’s the way to go because it’s going to involve long-term costs. And the Legislature, that’s their primary authority.”

Now, the conservative Kansas state legislature will hold a hearing on a proposal being crafted by the Kansas Hospital Association in talks with Brownback’s staff that would expand Medicaid in the state through Obamacare. It’s an odd situation given that Brownback, a conservative governor who’s gotten plenty of national attention for standing by his unusually deep tax cuts, has previously opposed expanding Medicaid through Obamacare.

The specific plan that’s been in the works between the Kansas Hospital Association and Brownback’s staff is meant to be acceptable to a Republican governor like Brownback, according to Ward, the Democratic state representative. It’s similar to other plans used in Republican-controlled states to expand Medicaid through the Affordable Care Act.

The plan, according to Kansas’s KCUR, would use federal Medicaid funds to let adults with low incomes buy private insurance coverage. Most important, though, is that the proposal strikes a law passed by conservative Republicans that bars the governor of Kansas from expanding Medicaid without first getting legislative approval.

“What the Hospital bill does is strike that law, repeal that,” Ward told TPM on Tuesday. “And then it directs the governor to engage CMS [Centers for Medicare & Medicaid Service] and get a waiver to expand Medicaid on the red-state model, which is vouchers to buy insurance through the exchanges, it has a work training requirement, and it also has some copay, similar to Arkansas and Indiana.”

In other words, the plan gives Brownback the opportunity to say he’s tricked the socialist Obama administration into paying for non-socialist Medicaid reforms that demand some personal responsibility from those people. And if the legislature’s removed from the picture, then Brownback pretty much has a monopoly on both negotiations and approval.

Meanwhile, HHS officials have to bite their tongues, roll their eyes, and for all I know, maybe have to tell reporters off the record that yeah, that Sam Brownback’s a tough negotiator, all right. It’s understandable: Anything to get people health insurance. I’m just kinda glad Kathleen Sebelius is no longer in a position of having to offer cover to Kansas Republicans engaged in this kind of charade.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.