TOPEKA, Kan. (AP) — Kansas officials are considering their next steps to implement the Patient Protection and Affordable Care Act (PPACA) now that the presidential election has been decided and deadlines are looming.
The state has until Nov. 16 to tell the federal government whether it wants to be a partner in creating an online health insurance marketplace. Insurance Commissioner Sandy Praeger's office is preparing a partnership application and will seek grant money to implement the exchange.
But to do so, Praeger, a moderate Republican, must get a letter of support for the state's partnership from Gov. Sam Brownback, a conservative Republican who is opposed to PPACA. The two are expected to meet this week to discuss the letter and application.
Both are elected officials and have been at odds over how the state should proceed in implementing the law.
Linda Sheppard, project manager for implementing the law, said Praeger's staff hadn't spoken with the governor about what is included in the state's application and didn't speculate on the chances of his approval.
"He has been very consistent that he has not wanted to talk about this and not willing to look at these issues until after the election," Sheppard said.
Brownback delayed the state's decisions hoping that a Mitt Romney victory would lead to a reprieve for states. However, with President Barack Obama's victory on Tuesday night and a ruling this summer by the U.S. Supreme Court upholding the law, chances of the law's repeal vanished.
The governor's spokeswoman, Sherriene Jones Sontag, declined to speculate whether Brownback would sign off on the insurance department's application to partner with the federal exchange.
PPACA was a factor in Tuesday's legislative election results, following the trend set in 2010 when Brownback was elected and large numbers of conservative Republicans were elected to the Legislature. Nearly all ran on the platform of opposing PPACA over concerns that it was an unconstitutional intrusion on state and individual rights.
Those victories were followed by more wins by conservatives in the August primary and on Tuesday, which marked defeats of moderate Senate Republican incumbents who opposed a measure to amend the Kansas Constitution granting so-called health care freedom choices to residents.
"The people of Kansas have spoken loudly three times, they want us to pursue Kansas solutions," Jones-Sontag said. "We are discussing options and alternatives with like-minded states and with our legislative partners in Kansas."
Sheppard said the state was applying to fill the roles of plan management and consumer assistance. She said because of timelines to implement the law that Kansas was unable to set up its own exchange. The insurance department would have to receive legislative approval to spend any federal dollars on the exchange partnership.
Pressure from the conservative Republicans last year prompted Brownback to reject $31.5 million in federal funds to help build the computer infrastructure necessary for an exchange.
States must have the exchanges in place and approve a basket of qualified plans that would be available for consumers to purchase that meet minimum federal guidelines.
In addition to the exchanges, the federal health care law says that in 2017, states must pick up 5 percent of the cost of the Medicaid expansion. The figure grows to 10 percent by 2020. In the past, states generally have been required to pick up about 40 percent of the cost, and in Kansas, the state's share for its $2.9 billion-a-year program is almost $1.2 billion.
Some state officials also worry that Kansas could face substantial new costs if it agrees to the Medicaid expansion because people who are now eligible without the expansion but not participating in the program also could seek coverage. That issue was noted by a Congressional Budget Office report in July.
House Minority Leader Paul Davis said he was concerned about the state's ability to expand Medicaid given Tuesday's new revenue estimates projecting a $327 million shortfall in the next state budget because of income tax cuts taking effect Jan. 1.
"There's no room for any spending initiatives. That is a big concern," said Davis, a Lawrence Democrat.
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