Kansas could become the 37^th state in the U.S. to opt for Medicaid expansion, good news for as many as 150,000 residents of the Jayhawk State who would have improved access to medical coverage – and the peace of mind and economic security that comes with it.

Kansas lawmakers recently announced a bipartisan compromise to expand Medicaid. The compromise still must pass through the House and the Senate, but the Senate Majority Leader, a Republican, says the measure already has enough cosponsors to pass his chamber. (House passage could be more complicated – last year, House members did approve Medicaid expansion, albeit a more restrictive version than what state leaders have agreed on.)

Kansas is the latest example of a “red state” (or, in some cases, “purple”) to opt in for Medicaid expansion under the Affordable Care Act. As recently as 2018, 31 states plus Washington, D.C. had approved expansion. On Jan. 1, 2019, Virginia became the 32^nd state, and that same year, Idaho, Maine, Nebraska and Utah followed suit, bringing the number of states to 36. (To clarify: Nebraska’s Medicaid expansion has been approved, but will not take effect until later this year.)

More states could be on the horizon: Advocates in Oklahoma already have gathered – and had certified – enough signatures to qualify a ballot measure on Medicaid expansion for the November 2020 election; advocates in Missouri are attempting a similar ballot measure — they have until May to gather and submit signatures. And in North Carolina, the governor vetoed an annual spending bill because it lacked Medicaid expansion; lawmakers in the House were unable to override his veto, giving him some leverage going forward in the area of expansion.

All in all, if those three states were to opt for expansion, it would bring the total number of Medicaid expansion states to 40 – meaning an even larger majority of Americans would live in expansion states and reflecting the underlying popularity of the Affordable Care Act. And it doesn’t stop there – advocates in South Dakota and Wyoming are optimistic that expansion could happen, although advocates in two other states – Florida and Mississippi – have been stymied in their efforts. (For a complete look at state-by-state expansion efforts, go here.)

If Kansas moves forward, the number of Americans who could receive Medicaid benefits in the six states that would have adopted Medicaid expansion since Jan. 1, 2019, would be just under 1 million – 983,000 Americans, according to a Voices for Human Needs tally of the number of newly eligible people in each state.

Why the progress toward expansion? In part, because the issue is politically popular – Medicaid expansion has passed all but once when it has appeared as a ballot initiative (and the one exception was Montana, an expansion state where the issue wasn’t exactly voted down, but rather lost because of disagreement over how to meet the state’s share of the expenses. The impasse has since been resolved, at least for now.)

In addition, successful pro-expansion candidates for governor in a number of states – Kansas and Kentucky included – have prevailed. And there is the lure of “free” federal dollars to pay for the program – in 2020 the federal government is paying 90 percent of the cost of expansion, with states required to make up the rest.

In Kansas and some other states such as Virginia, there could be another factor at work: the perilous fate of rural hospitals, some of which have had to shutter their doors and desperately need the dollars that Medicaid expansion would bring. For some communities, losing a hospital means long commutes for treatment, and losing the jobs provided by the community’s largest employer.

Reports the New York Times:

“The expansion debate in Kansas has been shaped by a wave of hospital closures in rural parts of the state. In some cases, that has forged unlikely alliances between rural Republicans and urban Democrats.

“Without expanded Medicaid, some rural hospitals have struggled with higher rates of uninsured patients and lower rates of repayment. One hospital that closed in Independence, Kan., in 2015 would have received an estimated $1.6 million a year if Medicaid had been expanded. Since then, three more rural hospitals have closed in the state.”

In closing, it is important to note that although the number of states expanding Medicaid is certainly good news, the future of Medicaid and the Affordable Care Act remains fraught with peril. First, the Trump Administration’s actions could strangle Medicaid expansion if it succeeds in convincing states to “block-grant” their programs. And second, as Voices for Human Needs recently noted, legal challenges to the entire ACA remain active – and if the law is completely struck down, then with it would go Medicaid expansion, along with a sweeping set of consumer protections.