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Kansas is one of only 10 states that has not expanded eligibility for Medicaid. Many Republican lawmakers there oppose it, and the state's Democratic governor is trying to get them to change their minds and open the health program to some 150,000 low-income residents. Rose Conlon of member station KMUW met one woman for whom the issue is personal.
ROSE CONLON, BYLINE: As a healthy college freshman, Marcillene Dover wasn't too worried about not having health insurance - until something changed.
MARCILLENE DOVER: I was about a month or two into classes, and I started having weird symptoms like numbness, tingling in my legs, trouble walking on campus, which was weird.
CONLON: Dover says her doctor thought it could be a pinched nerve, but to make sure it wasn't more serious, she would need an MRI, something she couldn't afford because she'd recently aged out of the Medicaid she'd had as a child.
DOVER: She said that's going to be at least $1,500 for you guys to pay out of pocket. And my mom, around that time - that was more than she had in savings. So it was not something that we considered as an option.
CONLON: It was another two years before Dover found a nonprofit to pay for the MRI. It showed that she had multiple sclerosis. Today, at 30 years old, she uses a wheelchair and says she might not have needed it if she'd started treatment sooner. Now, Dover advocates for Medicaid expansion, which is a top goal of Kansas Governor Laura Kelly. Kelly, a Democrat, has been trying for six years to expand Medicaid. And because it's an election year for the legislature, she's appealing directly to voters who, according to most polls, support expansion.
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LAURA KELLY: If we do not get Medicaid expanded this session, then I would hope that they make it the number one issue going into the November 2024 elections and that they hold their representatives accountable.
CONLON: She's up against the Republicans that control the Kansas legislature, like House Speaker Dan Hawkins.
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DAN HAWKINS: Medicaid expansion is a brand new population of predominantly childless adults aged 19 to 64, who can work. With Medicaid expansion, there is no reason to work. They've got their health care now.
CONLON: Most adults who'd be covered by expansion actually do work at least part time, according to the Kansas Health Institute, which seeks to increase health options for Kansans. Many fall into what's called the coverage gap. Kelly points out a single mom of two kids currently has to earn less than $10,000 per year to get Medicaid, and unless she makes over $35,000 per year, she doesn't qualify for subsidies that would make other plans affordable. But in an interview, Hawkins said expansion is too expensive and there's zero chance he'd support Kelly's plan.
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HAWKINS: She truly believes that the government should take care of everybody. And I don't. I believe that we all have an individual responsibility.
CONLON: A few Kansas Republicans do support expansion, including Representative Jesse Borjon, who thinks it's pro-family and pro-business.
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JESSE BORJON: One of the No. 1 issues that I hear from my constituents on is Medicaid expansion, and they can't understand why the legislature can't get it done.
CONLON: With urging from Borjan and others, the House Health Committee recently held a hearing on the governor's proposal, but a day later, the heavily Republican committee defeated it in a voice vote.
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UNIDENTIFIED PERSON: All those in favor signify by saying aye.
UNIDENTIFIED REPRESENTATIVES: Aye.
UNIDENTIFIED PERSON: Oppose, no.
UNIDENTIFIED REPRESENTATIVES: No.
CONLON: It's unlikely to get another chance this year, according to Neal Allen, chair of the political science department at Wichita State University.
NEAL ALLEN: Right now, the Republican Party, at least on the state level, doesn't want to expand Medicaid. And in Kansas, what Republicans want is what matters.
CONLON: Some states, including neighboring Missouri, Oklahoma and Nebraska, have expanded Medicaid through voter-led ballot initiatives. Those aren't possible in Kansas and most other states that remain holdouts. For now, advocates like Dover say they'll keep working.
For NPR News, I'm Rose Conlan in Wichita. Transcript provided by NPR, Copyright NPR.
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