Medicaid expansion remains one of the most talked about issues swirling through state government this year, where its prospects remain uncertain.

Democratic Gov. Laura Kelly made Medicaid expansion a cornerstone of her campaign, but conservative leaders in a Republican-controlled Legislature harbor ongoing objections to the cost of the Affordable Care Act, the reliability of expansion estimates and the concentration of funds in urban areas.

The ACA expanded eligibility of the program for disabled, pregnant and low-income residents, but a U.S. Supreme Court ruling struck down the expansion mandate, leaving the decision up to each state. For states that agree to provide coverage to those whose income is less than 138 percent of the federal poverty level — $16,000 for an individual or $34,000 for a family of four — federal funds cover 90 percent of the state's Medicaid costs.

Led by opposition from Republican Govs. Sam Brownback and Jeff Colyer, Kansas lawmakers rejected expansion as a government overreach, and pointed to states where costs exceeded projections. In 2017, a wave of newcomers led to passage of an expansion plan, but there wasn't enough support to override Brownback's veto.

That bill, which used research from the Kansas Department of Health and Environment, expected 150,000 new participants and a $26 million impact on the general budget for fiscal year 2020, which starts in July. Other studies have reached similar conclusions.

Kelly argues that the economic benefit to the flow of federal funding would erase the state's burden and aid struggling rural hospitals. She also sees it as a humanitarian issue.

"Healthcare is a critical need for all Kansans, and for too many, it’s still inaccessible and unaffordable," Kelly said. "My administration will work on a bipartisan plan to expand Medicaid so that more Kansans have access to health care, our rural hospitals can stay open, and the tax dollars we send to Washington come back home to Kansas to help our families."

Opponents aren't so confident in the economic impact and highlight concerns with the state's long-term financial outlook. If costs for Medicaid expansion exceed expectations, coupled with spending increases for schools, highways, foster care, pensions and other areas of state government, the state could be forced to raise taxes.

House Speaker Ron Ryckman, R-Olathe, said many questions remain unanswered. Most of the federal dollars would be funneled to medical facilities in Sedgwick, Johnson and Wyandotte counties, he said.

"We're always open to ideas," Ryckman said. "What we don't want to do is give false hope, especially a lot of our rural hospitals."