Kansas has another neighbor expanding Medicaid — and this time, it is different.
Last Tuesday, Missouri voters passed a constitutional amendment expanding Medicaid by a vote of 53% to 47%. Nebraska voters passed expansion in 2018 and Oklahoma voters did so earlier this year. Colorado passed it in 2013. 
Kansas is now surrounded by expansion states, but this one is different, because Kansas’ most-populated border lies on the Missouri state line, while the borders with those other states are largely rural.
About one in three Kansans live in the bi-state Kansas City area. People, jobs and commerce flow freely across the border, old rivalries notwithstanding. No one sees that more acutely than KC’s hospitals, which all treat their share of patients from both states. In fact, the massive KU Medical Center complex is right on the state line.
Assuming Missouri’s Republican leaders do not find a way to derail the voter-approved amendment, these hospitals and doctors’ offices will now see a big gap in coverage depending on which state a patient calls home.
Will this increase pressure on Kansas to pass expansion too? Not necessarily. The Kansas Legislature passed expansion in 2017 with solid majorities, but it was vetoed by then-Governor Brownback on the grounds of being too expensive, and there were not enough votes in the Senate to override. Polls show that a slim majority of Kansans do favor the policy, but many also believe that those who are able should pay some type of premium or co-pay or be subject to a work requirement. In 2020, before COVID, a likely passage of expansion was derailed by abortion politics — bad timing, since care for many who suffer complications from COVID, as well as coverage for those who have lost their jobs due to the pandemic would both have been accessible to more people had it passed, up to 138% above the poverty line. It may not be a coincidence that Missouri and Oklahoma both passed expansion during the pandemic.
Some of those Kansas legislators who voted for expansion in 2017 were defeated this time. In fact, the near-rout of moderate Republican legislators by conservatives last week probably means fewer votes for expansion, even if Democrats seize on the opportunity to beat the conservative nominees in November. With only a few exceptions, this opportunity for Democrats appears most likely in Johnson County.
Politically, this will only deepen the split between the KC area and the rest of Kansas. The Greater Kansas City Chamber of Commerce backed Missouri’s Medicaid expansion and would likely do the same in Kansas, while the Wichita-based Kansas Chamber — in which Koch Industries plays an outsized role — opposed it. The irony here is that the KC area will drive the push for expansion while the biggest beneficiaries would be rural hospitals, which are particularly at risk if expansion does not pass, and soon. It is also notable that Missouri, Nebraska, and Oklahoma are all Republican-leaning states which passed expansion via petition-initiated ballot initiative, a provision which Kansas does not have.
In sum, last week’s election results promise to further pull Kansas in opposite directions on this critical issue. The next chapter will be written in November.
