The complex Medicaid expansion bill endorsed by a Republican-dominated Senate committee Wednesday offered health insurance to an estimated 150,000 low-income Kansans and inspired skepticism from conservatives opposed to government growth and from moderates uneasy with the plan's many moving parts.

The package developed by Senate Majority Leader Jim Denning, a Johnson County Republican, remained largely intact after two days of committee testimony and debate at the Capitol. The plan forwarded to the 2020 Legislature differed markedly from the more straightforward approach preferred by Democratic Gov. Laura Kelly. It also ran contrary to the bipartisan Medicaid bill passed by the Kansas House in the 2019 session.

The committee's politically volatile bill, even with the federal government covering 90% of Medicaid expansion costs, would require the state to come up with $121 million for Medicaid expansion. The outline also featured allocation of $50 million to help Kansans with private-sector insurance available in the Affordable Care Act marketplace and creation of a $30 million rainy-day fund for the state's unexpected Medicaid cost spikes.

Denning said the state budget couldn't sustain the high-level expenditures without a $50 million increase in state tobacco and vaping taxes, a $31 million surcharge on hospitals and a $63 million fee assessed managed-care organizations serving Medicaid clients.

"We can't put any more stress on the state general fund," Denning said. "There is no money from SGF for this expansion."

Kelly, who has made Medicaid expansion her top policy priority of the next legislative session, said Kansas should draw upon the best elements of plans existing in 36 states that broadened eligibility to more people living in poverty without accessible, affordable heath coverage.

"We need a Medicaid expansion plan that is simple, effective and sustainable for Kansas," Kelly said. "We don’t need to create extra bureaucratic red tape, raise taxes and create more hurdles to access to health care. It’s important that we get this right to best serve the 150,000 Kansans in need of health care coverage right now.”

Senate Minority Leader Anthony Hensley, D-Topeka, rattled off more than a dozen objections to the Senate GOP-inspired Medicaid bill. He was critical of Denning's preference for seeking federal approval of two partial expansion options before applying for the standard expansion of eligibility for Medicaid to those earning up to 138% of the poverty level, which is $29,000 per year for a family of three.

"We've got a long way to go with this debate," said Hensley, the longest-serving legislator in Kansas history. "I think there's a lot of posturing here. Senator Denning is going to have to have Democrats to get this bill out of the Senate. That means compromise."

Thirty-six states and the District of Columbia moved ahead with Medicaid expansion since the Affordable Care Act became law in 2010. Kansas stands among 14 states that declined, a policy position pushed by Republican Govs. Sam Brownback and Jeff Colyer.

Sen. Pat Pettey, a Democrat from Kansas City, Kan., said a "gigantic flaw" in the Senate committee's bill was lack of a date certain for implementation of Medicaid expansion in Kansas.

Conservative Republican senators on the committee questioned lack of a specific provision in the bill prohibiting abortions to be paid by Medicaid, while others were concerned about insurance cost shifts from individuals to the commercial sector. The committee agreed to hold the Kansas Hospital Association responsible for a study of the burden on hospitals of uncompensated care. The panel urged KHA and the University of Kansas Health System to develop a project on rural health care reform.

"I'm trying to get information to protect my constituents," said Sen. Ty Masterson, a Republican on the committee.

Elizabeth Patton, deputy state director for Americans for Prosperity of Kansas, said the bill ushered through the committee doubled down on "an already broken Medicaid system."

"Lawmakers should focus Medicaid resources on Kansas’ most vulnerable, rather than adding able-bodied, working adults to an unsustainable program," she said. "We also encourage lawmakers to pursue bipartisan policy solutions, such as eliminating unnecessary collaborative agreements for nurse practitioners, which would immediately enable many more Kansans, particularly in rural Kansas, to access vital health care services."