TOPEKA — Financially fragile hospitals in Kansas — especially facilities in rural areas of the state — have a lot to lose in the Kansas Legislature’s debate about expanding Medicaid services.

The Alliance for a Healthy Kansas reported 31 of the state’s 107 hospitals are financially vulnerable because each must grapple with costs of providing care to people who are uninsured.

The Senate voted 25-13 on Monday to send the Medicaid expansion bill, House Bill 2044, to final action on Tuesday. Expansion would deliver Medicaid services to about 150,000 more Kansans.

“We have to consider those 31 at-risk hospitals that we ask every day to absorb costs from uninsured patients because they do not have access to affordable health insurance. If we continue to let this condition continue, we’re likely to see more hospitals close in the rural parts of the state and that would be a true travesty,” Sen. Randall Hardy, R-Salina, said during the Senate debate.

In 2015, the Mercy Hospital System facility in Independence was forced to close because of declining population in the area and the financial burden of uninsured patients. With a population of over 9,000, Independence is the largest community in Kansas without a hospital.

“My question is how do you think the residents of Independence, Kansas would urge us to vote today?” Hardy said.

According to the Kansas Hospital Association, Kansas has forfeited more than $1.7 billion in federal funds since January 2014 by declining to expand Medicaid under the Affordable Care Act.

Tom Bell, chief executive officer of the KHA, provided testimony to a Senate committee that indicated expansion would lead to an average benefit of $913,418 for the 16 rural, non-critical access hospitals across the state.

Mark Woodring, Coffeyville Regional Medical Center’s chief executive officer, testified that more than 45,000 southeast rural Kansans are in need of access to affordable health care.

“Expanding KanCare would not only provide thousands access to health care, preventative screenings and diagnostic testing to vulnerable patient populations, but would boost our economy and help create jobs in one of the most impoverished part of Kansas,” Woodring said. “Expansion would also ease the heavy financial burden currently being experienced by CRMC. Since the closure of the Independence hospital, CRMC charity care and bad debt at our facility has doubled.”