Missouri’s push for Medicaid expansion runs into Republican opposition

Nov. 30--The door hasn't completely shut on expanding the public health insurance program for the poor in Missouri.

The broad coalition backing Medicaid expansion, including groups representing business and hospitals that have traditionally supported Republicans, remains intact. And Democrats such as Gov. Jay Nixon, who've made expansion a legislative priority, have signaled a willingness to accept a host of Republican ideas for reforming Medicaid in the hopes of winning GOP support.

Still, even the staunchest supporters of expansion admit that the uphill battle they've long faced may just be getting steeper.

"I am more pessimistic than I was this summer," said Sen. Paul LeVota, an Independence Democrat.

The latest setback for supporters came when a public summit called by Nixon to discuss Medicaid with legislative leaders was scrapped when Republican lawmakers balked at the governor's plan to hold the gathering outside the Capitol. Instead, they insisted the governor testify before a joint legislative committee.

Nixon panned the idea, and both sides accused the other of political posturing.

Less than a week earlier, a committee in the Missouri Senate tasked with studying Medicaid rejected expansion outright, causing three Democrats on the committee to storm out of its final meeting in protest.

"I don't think there's a lot of support for Medicaid expansion," Senate Majority Leader Ron Richard, a Joplin Republican, said in an interview with Missourinet. "At least, there's nobody in the Senate calling me that we want to expand Medicaid."

Sen. Rob Schaaf, a St. Joseph Republican, took that a step further at a gathering of Republicans in Moberly, telling the crowd, "I will stand and filibuster expansion of Medicaid until I can't stand any longer. And I know other senators who would do the same."

The politics of the health care law make expansion a difficult sell in Missouri, said Rep. Noel Torpey, an Independence Republican who chaired a House committee that took public testimony about Medicaid all summer.

GOP lawmakers who support expansion face the threat of a primary, Torpey said, pointing to a bill passed unanimously out of the Missouri House two years ago creating a state-based health exchange -- another key provision of the federal health care law.

"It died in the Senate, and the House never really seriously considered health exchanges again," Torpey said. "But that exchange bill ended up being used against people in primaries. I don't think people have forgotten that."

Add into that the "just disastrous rollout" of the federal health care law, Torpey said.

"The Affordable Care Act and the stumbling blocks it's had has hurt the chances of Medicaid expansion," he said.

To many Republicans, Torpey said, there are major concerns about the long-term costs both to the federal and state governments.

Dan Mehan, president of the Missouri Chamber of Commerce and Industry, said the key to success will be to somehow separate Republican opposition to the Affordable Care Act from the issue of Medicaid expansion.

"Nobody said it was going to be easy," said Mehan, whose organization is one of the most outspoken supporters of Medicaid expansion. "There's always hope. Every legislative session starts with a clean state."

Supporters hang their hat on the idea that Medicaid expansion will inject billions of additional dollars into Missouri's economy.

The Affordable Care Act calls for states to expand eligibility for Medicaid to 138 percent of the federal poverty line -- about $32,000 for a family of four. That's up from the current eligibility threshold of 19 percent. Expanded coverage would be fully funded by the federal government until 2016, when the state begins to gradually pick up a share of the costs. Beginning in 2020, the federal government would pay 90 percent of expanded Medicaid costs, and the state would shoulder 10 percent.

If lawmakers choose not to expand Medicaid, nearly 200,000 Missourians will find themselves stuck in a so-called coverage gap, earning too much money to qualify for Medicaid but too little to qualify for subsidies to offset the cost of private insurance through the federal exchange. In Kansas, which has also foregone Medicaid expansion, about 78,000 people fall into the gap.

In addition to the infusion of federal money, a plan drafted by Rep. Jay Barnes, a Jefferson City Republican, purports to save the state around $42 million a year by implementing several reforms to the Medicaid system in exchange for expansion.

Barnes' plan would expand its Medicaid eligibility limits for adults to 100 percent of the poverty level. That would make insurance available to about 225,000 adults. An additional 82,000 Missourians who earn slightly more than the poverty level would receive help purchasing an insurance policy in the federally run exchange.

To offset costs, children in lower- to middle-income families would be moved out of Medicaid and into the insurance exchange. The plan also would expand Medicaid-managed care statewide and make various market-oriented reforms.

Any changes made to the Medicaid system will hinge on getting a waiver from the federal government, Torpey said. And without expansion, there is no way a waiver will be granted.

"We should do those reforms, but the mom who has two kids and two jobs but can't afford health care, why not help that person, too?" Torpey said, later adding: "There's got to be room for compromise. I think everyone can win."

To reach Jason Hancock, call 573-634-3565 or send email to [email protected].

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