<figure>
 <img src="https://media.eaglewebservices.com/public/2020/1/1579714677583.jpeg" alt=" Republican Sen. Gene Suellentrop, left, will chair hearings on a compromise Medicaid expansion plan starting this week. Daniel Caudill / Kansas News Service" />
 <figcaption> Republican Sen. Gene Suellentrop, left, will chair hearings on a compromise Medicaid expansion plan starting this week. Daniel Caudill / Kansas News Service</figcaption>
 </figure>By JIM MCLEAN <a href="https://www.kcur.org/post/4-ways-medicaid-expansion-opponents-kansas-might-still-sink-deal#stream/0">Kansas News Service</a>TOPEKA — Medicaid expansion is a done deal, right?Democratic
 Gov. Laura Kelly and Jim Denning, the second most powerful Republican 
in the Kansas Senate, have compromised on a plan. Together, they bring a
 majority of lawmakers with them. So, game over.Sure, the deal 
still needs to clear the Legislature and get the blessing of federal 
regulators. But the hard part — breaking an almost decade-long stalemate
 on the issue — looks done.Expansion supporters finally have 
reason to believe that an estimated 130,000 to 150,000 more low-income 
Kansans will soon have taxpayer-funded health coverage.Probably. But not necessarily.A
 relatively small but committed group of lawmakers could still slow — 
theoretically, even kill — the deal. They could continue their fight by 
simply amending the Medicaid expansion legislation to pick apart the 
terms of the compromise.Their first chance comes this Thursday 
when the Senate Public Health and Welfare Committee starts hearings on 
the compromise bill.Republican Sen. Gene Suellentrop chairs the 
committee, where expansion opponents hold a numbers advantage they don’t
 have in the full Senate. Suellentrop expects them to tack on several 
amendments. It’s their chance to weigh in on that Kelly-Denning bargain,
 or what he calls a “kind of a side-negotiated deal.”Here are four things that opponents could add to upset the carefully balanced compromise:<ul>
 <li>A
 work requirement: Conservatives say requiring non-disabled adults to 
get a job or prove they’re looking for one promotes accountability. 
Kelly says studies show that work requirements cost too much to run and 
mistakenly deny coverage to some. Federal regulators and the courts have
 blocked work requirements in some states.</li>
 </ul><ul>
 <li>&nbsp;Higher 
premiums: Under the compromise, people earning between 100% and 138% of 
the federal poverty level ($25,750 to $35,535 for a family of four) 
would need to pay monthly premiums. Up to $25 for individuals, no more 
than $100 for a family. Increasing those premiums could jeopardize 
federal approval land the state in court.</li>
 </ul><ul>
 <li>&nbsp;Non-payment
 penalties: Previous expansion plans would have penalized people for not
 their premiums by “locking them out” of coverage. Lockout periods in 
those proposals ranged from several months to a lifetime. Kelly and 
expansion supporters oppose such penalties and say they could also 
jeopardize federal approval.</li>
 </ul><ul>
 <li>Partial coverage: The 
position Denning started with would have expanded Medicaid only to those
 at or below the poverty line. He proposed giving subsidies to those 
making up to the eligibility threshold to help them purchase regular 
health insurance on the federal (Obamacare) exchange. Arguing that 
federal regulators would reject the two-tier approach, Kelly persuaded 
Denning to abandon the idea.</li>
 </ul>Expansion supporters say 
they’re prepared to strip such deal-changers out during debate on the 
Senate floor. With 22 of the Senate’s 40 members signed on as cosponsors
 of the bill, they’re confident they have the votes to clean it up.Even
 so, Denning is concerned about efforts to undo the compromise. In a 
lengthy statement this week, he criticized conservative Republicans for 
leveling “relentless attacks” at the plan.“Anyone can count the 
votes and see that Medicaid expansion is going to happen,” Denning said.
 “Compromise is a part of leadership and I am proud of the plan that 
Governor Kelly and I have agreed upon.”If the expansion deal clears the Senate relatively intact, it could still face hurdles in the House.Most
 House members support expansion, but Republican leaders don’t. Those 
leaders are threatening to hold expansion bill hostage for leverage over
 another hot-button issue: abortion. That’s a potential fifth way to 
derail the Medicaid compromise.Jim McLean is the senior 
correspondent for the Kansas News Service is a collaboration of KCUR, 
Kansas Public Radio, KMUW and High Plains Public Radio focused on 
health, the social determinants of health and their connection to public
 policy. You can reach him on Twitter <a href="https://twitter.com/jmcleanks">@jmcleanks</a> or email jim@kcur .org.

4 ways Medicaid expansion opponents in Kan. might sink deal