Kansas House speaker meets opposition as he makes case against Medicaid expansion in Plainville

House Speaker Dan Hawkins chats with attendees of a town hall meeting April 11, 2024, in Plainville. Hawkins outlined his opposition to Medicaid expansion during the gathering organized by Rooks County Republicans. (Dale Hogg for Kansas Reflector)

PLAINVILLE — House Speaker Dan Hawkins faced criticism from rural health officials and residents last week when he traveled to Plainville to speak in opposition of Medicaid expansion.

Hawkins, a Republican from Wichita, addressed Rooks County Republicans during an April 11 gathering at Plainville’s Township Hall. The evening included a meal provided by Americans for Prosperity, a conservative lobbying group.

The GOP leader is fiercely opposed to Medicaid expansion, which would provide health care coverage to an estimated 152,000 low-income Kansans, and to Democratic Gov. Laura Kelly’s efforts to promote the policy.

The town hall-style meeting was in part a response to local debates over the idea, a flurry of letters to the editor in the Plainville Times and vocal support for expansion by Mark Schaukowitch, a Plainville resident. The Rooks County Conservative Alliance invited Hawkins to speak.

Hawkins repeatedly made disputed claims about the impact of Medicaid expansion on Kansas taxpayers, struggling rural hospitals and employment.

“We don’t want to make a huge mistake,” Hawkins said, addressing the capacity crowd. “Medicaid expansion is a huge mistake.”

Kelly’s proposal for Medicaid expansion includes a work requirement with exceptions for full-time students, veterans, caregivers, people with partial disabilities, and former foster kids. It includes a new surcharge for hospitals that would benefit from the influx of $700 million in federal cash. The Kansas Health Institute estimates the plan would not cost the state anything for the first eight years.

But Hawkins said Kelly’s plan was “smoke and mirrors.” As he went through slides in a PowerPoint presentation, he fielded questions from audience members.

And audience members pushed back.

Beth Oller, a Plainville physician who runs a practice with her husband, Mike, took Hawkins to task for generalizing that doctors and those in the medical field oppose expansion. Oller said they are tired of turning patients away or having to base treatment on a patient’s ability to pay.

“I talk to doctors all the time,” Hawkins said.

“Not as many as I do,” Oller said, as the exchange grew heated.

“I didn’t come here for an argument,” Hawkins said.

Oller’s comments are consistent with more than 100 health professionals and administrators who sent a letter in January asking the Legislature to expand Medicaid.

Concerns over such confrontations prompted meeting organizers to ask for questions to be submitted.

Schaukowitch, the vocal supporter of Medicaid expansion from Plainville, asked Hawkins about his work as an insurance salesman.

“Can you address your conflict of interest?” Schaukowitch said.

“We have nothing to do with Medicaid,” Hawkins said.

Hawkins on his website describes the Hawkins Group, which he owns, as “an employee benefits insurance agency.” His 2023 statement of substantial interests, which elected officials are required to file with the state, says he receives fees or commissions from United Healthcare, Vision Care Direct, Delta Dental of Kansas, and Blue Cross and Blue Shield of Kansas, among other insurance companies.

Members of the Kansas Silver Haired Legislature came to hear Hawkins speak. Members said expansion has long been important to them.

“It’s one of our top priorities,” said Steve Watts, the organization’s northwest Kansas chairman. “It is something we’ve supported since it was possible.”

A capacity crowd on April 11, 2024, filled the Plainville Township Hall to hear House Speaker Dan Hawkins talk about Medicaid expansion. (Dale Hogg for Kansas Reflector)

Making his case

According to Kelly, who scheduled a pro-expansion appearance at Hays Medical Center a few hours ahead of Hawkins’ speech 25 miles north of Hays, the Cutting Healthcare Costs for All Kansans Act would create 23,000 new jobs in Kansas.

She included a work requirement in her proposal to address concerns raised by Hawkins and other opponents of Medicaid expansion, who say the program would serve “able-bodied adults.” In reality, most people who would benefit from Medicaid expansion are already working or suffer from chronic illness. They include small business owners and their employees, as well as students, cancer patients and those who need mental health treatment.

Hawkins said the governor’s work requirements are “a joke.”

Under Kelly’s proposal, people would have to prove they are employed in order to sign up for services and renew them each year. The state health secretary would develop exceptions to allow enrollment by full-time students, caretakers, veterans and those with medical conditions.

However, Hawkins said, an applicant who only has to reapply once a year only has to prove they had one paycheck.

“Nowhere in that work requirement does it say you have to work a certain number of hours,” he said.

He claimed that “workforce participation will decline” and that Medicaid expansion would be an incentive not to work. Those concerns have not been realized in the 40 states that have already expanded Medicaid. According to the Kansas Health Institute, 68.9% of adults who would qualify are already working.

Hawkins said some of the people in the target group for Medicaid expansion are already eligible for coverage through their employer or the Affordable Care Act. Those individuals would be taken off of private plans and placed into the government program, he said.

Kansas’ version of Medicaid, known as KanCare, is available to children, their parents, pregnant women, seniors and people with disabilities. Only those who earn less than 38% of the federal poverty level are eligible. For a family of four, the annual income limit is $11,400.

Under the ACA, the federal government covers 90% of the cost of Medicaid services in exchange for expanding eligibility to 138% of the federal poverty rate. The annual income threshold for a family of four would be $41,400.

Hospital administrators say Medicaid expansion will have a dramatic positive impact on their bottom line. But Hawkins claimed they won’t actually see a benefit by adding services at Medicaid reimbursement rates.

In Kansas, eight rural hospitals have closed since 2015. Another 27 have been operating at a loss for the past three years and are at immediate risk of closing, according to data from the Center for Healthcare Quality and Payment Reform.

Hawkins said the state has to set priorities: Does it want Medicaid expansion or good roads and quality schools?

“Once you have this, you’re not going to get rid of it,” he said, because there would be too much political fallout with trying to reverse course.

Kansas is losing population and federal COVID relief money will eventually dry up, Hawkins said. He also claimed there is no proof that expansion will do anything to improve health care outcomes.

“There’s no magic pot of money. We’re going to have to pay the piper,” he said. “You should say no because you are the ones who are going to have to pay for it.”

Mike McCorkle, a Democratic challenger to GOP House Speaker Dan Hawkins, speaks to Tonia Goertz, a reporter for the Plainville Times, before the presentation by Hawkins. (Dale Hogg for Kansas Reflector)

Status of legislation

Mike McCorkle, a Democrat who is challenging Hawkins for his Wichita district seat, traveled 200 miles to hear Hawkins speak.

Hawkins introduced McCorkle to the crowd.

“We’re going to have a good campaign,” Hawkins said. “Some of you are going to agree with me and some of you are going to disagree, and that’s OK.”

Hawkins said he has been willing to “work across the aisle” and that divisions within the Legislature are not as bad as portrayed by news media.

“Don’t believe everything you hear about,” Hawkins said.

McCorkle didn’t offer any remarks. He just sat in the audience.

The Senate is scheduled to consider a motion to debate the governor’s proposal when lawmakers return next week.

Earlier this session, Hawkins and Senate President Ty Masterson allowed committee hearings on Medicaid expansion for the first time in four years.

According to testimony in those hearings, at least 70% of registered voters in Kansas support Medicaid expansion. That includes a slight majority of Republican primary voters and 83% of small business owners.

All of the states bordering Kansas have expanded Medicaid.

“We have left more than $7 billion in Washington, D.C., as one of the last 10 states to expand Medicaid,” Kelly said this week after a meeting on Medicaid expansion with law enforcement officials in Topeka. “This influx of funding would have an enormous impact by decreasing the financial burden on our jails and county taxpayers and increasing access to mental health care services for all Kansans. When the Legislature reconvenes next week, it is time for legislators to debate and vote on Medicaid expansion.”

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