We’re not in Kansas anymore

The Observer editorial board

Kansas Gov. Sam Brownback vetoed Medicaid expansion, which his fellow Republicans helped pass last week.
Kansas Gov. Sam Brownback vetoed Medicaid expansion, which his fellow Republicans helped pass last week. TNS

Medicaid expansion in deep red Kansas? It could happen, and if it could happen there, it could happen anywhere, including North Carolina.

Health care advocates planned to spend the weekend deluging Kansas legislators with phone calls and emails, urging them to expand Medicaid to some 150,000 residents. The House and Senate – each controlled by Republicans – approved the expansion easily last week, and now will try to override a veto from Gov. Sam Brownback.

It’s a dramatic turnaround in a conservative state, and one that could foreshadow similar efforts elsewhere. Thirty-one states expanded Medicaid under the Affordable Care Act, and many of the other 19 have cited the ACA’s possible repeal as a reason to stay out of the fray. With the failure, for now, of Republican efforts to get rid of Obamacare, states have more leeway to act.

Kansas soundly rejected Medicaid expansion previously. But moderate Republicans and Democrats won some seats in November. That – combined with the financial struggles of small, rural hospitals – changed the calculations. The Senate passed expansion 25-14 and the House passed it 81-44. Supporters need a handful of votes to override Brownback.

Many of those supporters are Republican. They join other Republicans, including Arizona Gov. Jan Brewer, Michigan Gov. Rick Snyder and Ohio Gov. John Kasich, in recognizing the boost the billions in federal dollars give to a state, its hospitals and its low-income patients.

Dare we hope that Republicans in North Carolina’s legislature change their minds? That’s probably overly optimistic, but Kansas’s example shows that with just a little turnover at the ballot box, it’s possible. In the meantime, the best chance for Medicaid expansion here is Gov. Roy Cooper’s effort to achieve it through executive action. A judge has stalled that effort and its future is uncertain.

Just like the future of hundreds of thousands of North Carolinians who make too much to receive Medicaid and too little to afford health insurance.