TOPEKA, Kan. (AP) — Democratic Gov. Laura Kelly is more aggressive and openly political in pushing to expand Medicaid in Kansas as the Republican-controlled Legislature prepares to open its annual session Monday following five years of failed efforts to provide state health coverage to another 150,000 people.

Kelly confronts Republican supermajority leaders who are focused on reducing income taxes and controlling local property taxes, rather than expanding Medicaid.

However, Kelly’s latest strategy involves aggressively targeting Republican opponents of expansion in upcoming legislative races, which goes against her previous image as a nonpartisan mediator uninterested in political games.

During a recent interview, Kelly stated that her previous method of bringing people together and working collaboratively to reach a consensus and implement effective policies has not been successful.

“Perhaps a more assertive and, to be blunt, a more politicized approach could be the solution,” she suggested.

Over the course of several months, Kelly has been traveling around the state to hold press conferences and roundtable discussions in order to gain backing for the expansion of Medicaid. She stated that she took inspiration from the campaign of Democratic Governor Roy Cooper in North Carolina, where a predominantly Republican legislature implemented expanded coverage starting on December 1st.

Kansas is one of 10 states that have not followed the 2010 federal Affordable Care Act by expanding Medicaid. This act promises to provide federal funding for 90% of the additional costs. In two other states, Georgia and Mississippi, prominent Republicans have shown a willingness to consider expansion this year, so the matter is not completely closed.

Conservative opposition in Kansas stems from a belief in smaller government and longstanding doubts about social services. During the autumn season, Republican leaders Dan Hawkins and Ty Masterson, who represent the Wichita area, criticized Governor Kelly’s meetings with business leaders, hospital administrators, and health advocates as a “Welfare Express Tour” promoting increased government reliance.

Hawkins stated in an email that he opposes using taxpayer money to provide free healthcare for a group of healthy, unemployed individuals without children who choose not to work.

Some residents of Kansas struggle with making ends meet.

Robyn Adams, who is 46 years old and resides in Newton, works part-time for 15-20 hours a week. She also takes care of her 15-year-old daughter and utilizes a program provided by the manufacturer to avoid the cost of $1,500 every two weeks for her rheumatoid arthritis shots.

By increasing her work hours, she no longer qualified for Medicaid and did not meet the requirements for government assistance in purchasing private insurance. She stated that even a $40 copay before seeing a doctor can be a financial burden and paying a higher monthly insurance premium is not feasible.

She stated that low-income families also require insurance. She expressed concern that without the expansion, many families will face difficulties.

Kelly has required individuals who would now be eligible for Medicaid to confirm every year that they are employed in order to gain support from the GOP. However, Masterson stated to the media, “The fundamental truths remain unchanged.”

In the state of Kansas, individuals without children or disabilities are not eligible for Medicaid. When a household’s income reaches 38% of the federal poverty level, parents such as Adams are no longer covered. This amount is less than $7,500 for a single parent with one child and $11,400 for a family of four.

A potential increase would allow both categories to qualify if their income falls within 138% of the federal poverty level. For a single adult without children, the maximum income would be $20,100; for a single parent with one child, it would be approximately $27,200; and for a family of four, it would be $41,400.

According to KFF, a research organization formerly known as the Kaiser Family Foundation, 73% of eligible individuals belong to families with at least one employed member, either full- or part-time. Sean Gatewood, a former Kansas House representative and spokesperson for the KanCare Advocates Network, a group in favor of expansion, stated that many of these individuals work in the service industry or are self-employed.

Kelly’s proposed changes would result in a 31% rise in expenses for the Kansas Medicaid program, amounting to approximately $1.35 billion annually. However, the majority of this cost would be covered by federal funds, leaving only $135 million for the state to cover. This remaining amount would be offset by implementing fees on hospitals and major private health insurance companies.

The non-expansion states that have not yet accepted the offer will be given a financial incentive by the federal government. GOP lawmakers in North Carolina were swayed by the promise of an extra $1.8 billion over two years. Kelly’s office anticipates that Kansas will receive a bonus of $370 million to $450 million.

However, even if there is sufficient backing to approve a measure that broadens eligibility, Hawkins, Masterson, and their allies have the power to prevent it from passing through committees. Democratic efforts to propose expansion plans during discussions on other actions have been deemed inappropriate, and even Republicans who support expansion have sided with their leaders on this matter.

Kelly and other supporters, however, believe there are numerous justifications to continue advocating, especially considering the accomplishments of North Carolina Governor Cooper.

Cooper contended that Republican legislators in his state were influenced by a unique alliance that consisted of rural chambers of commerce and “tough-on-crime” Republican sheriffs. These individuals believed that they were facing a high number of individuals who primarily required access to healthcare, rather than being arrested.

In a press conference, Cooper expressed his hope that non-expansion states can learn from the successful coalitions we have formed.

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Gary Robertson, a writer for the Associated Press in Raleigh, North Carolina, also made contributions.