Kansas’ conservative governor vetoed a bill Thursday that would have extended the state’s health coverage for the poor under former President Barack Obama’s signature health care law, setting up a likely showdown with the Legislature.

Republican Gov. Sam Brownback argued that the proposed expansion of the state’s Medicaid program would fail to serve “the truly vulnerable” ahead of “the able-bodied,” and that it would burden the state budget with “unrestrainable entitlement costs.”

When the Republican-controlled Legislature gave final approval to the measure Tuesday, it had strong bipartisan majorities in both chambers, but supporters were short of the two-thirds margins necessary to override a veto. Nevertheless, they planned to try, with a vote first in the state House as early as Monday.

Brownback has been a vocal critic of the 2010 Affordable Care Act, also known as “Obamacare,” and his veto was expected. He previously could count on fellow GOP conservatives who opposed the former Democratic president’s policies to block a Medicaid expansion.

But voters last year turned on the governor and elected more Democrats and moderate Republicans to the Legislature, forcing a debate. Advocates for the uninsured never abandoned their push, and the Kansas Hospital Association backed an expansion, believing it could keep dozens of rural hospitals open.

“Are we going to wait for some more hospitals to close?” said state Rep. Susan Concannon, a rural central Kansas Republican. “Are going wait until we have people die that can’t get insurance?”

Republican critics of an expansion pointed to President Donald Trump’s promise to repeal and replace the 2010 health care law. Brownback argued in his annual State of the State address in January that expanding Medicaid under its provisions would be “airlifting onto the Titanic.”

But the failure of a repeal effort by Trump and U.S. House Republican leaders last week buoyed supporters’ hopes. Democratic governors in North Carolina and Virginia also want to expand their Medicaid programs; Maine has an expansion proposal on the ballot in November.

Obama’s health care law encouraged states to expand their Medicaid programs by promising to pay most of the costs.

Brownback’s administration calculated that the state would still face significant extra Medicaid expenses as it wrestles with projected budget shortfalls totaling more than $1 billion through June 2019. The state’s budget woes followed massive personal income tax cuts in 2012 and 2013 that Brownback championed and slumps in agriculture and energy production.

“This one piece of legislation could chart a course of financial disaster for us for a long time,” said Republican Rep. Dan Hawkins, of Wichita, the chairman of the House health committee.

The hospital association argued that the extra federal dollars would ripple through the economy and it calculated that the state would see a budget gain.

Brownback also said in his veto message that the expansion bill lacked a work requirement for the non-disabled adults it would have covered. He dismissed a provision that would require the state to refer such people to job training programs if they were working fewer than 20 hours a week.

In addition, the governor, a strong abortion opponent, argued, “Most grievously, this legislation funnels more taxpayer dollars to Planned Parenthood and the abortion industry.”

At Brownback’s direction last year, the state health department attempted to cut off Medicaid reimbursements to Planned Parenthood affiliates for non-abortion services, but a federal judge blocked the move. Federal law prohibits taxpayer funding of most abortions.

A Planned Parenthood Great Plains clinic in the Kansas City area is one of three in Kansas that provides abortions, along with other services. An expansion could mean that it could see a greater number of patients with Medicaid coverage — just as other health care providers would.

President and CEO Laura McQuade said Brownback’s veto “was about denying his constituents health care.”

TOPEKA, Kan. (AP) Copyright 2017 The Associated Press.

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