Fight over Medicaid expansion shaping up in Missouri
Barb ShellyAs you may have heard, some sore losers who didn’t like the way the national election turned out have petitioned for Missouri to secede from the union.
That prompted a more fun-loving group to ask that the rest of the nation be treated to a gigantic pizza party in the event of Missouri’s departure.
It’s probably a bit early for the partiers to be firing up the ovens, however. Before it takes on the rest of the union, Missouri must resolve the war within itself.
Democratic Gov. Jay Nixon threw down the gauntlet Thursday when he announced his 2014 budget would include federal money to vastly expand the state’s Medicaid program.
“It’s the smart thing to do and it’s the right thing to do,” Nixon said.
There is, to put it mildly, some disagreement about that.
Lt. Gov. Peter Kinder, a Republican, said an expansion would be “ruinous,” although all evidence suggests otherwise.
Republican House Speaker Tim Jones tweeted about the perils of the “welfare state,” a term unfairly calculated to conjure up visions of shiftless freeloaders. Most of the Missourians who would benefit from a Medicaid expansion work really hard.
Medicaid is destined to once again become the flashpoint of a legislative session.
Republican Gov. Matt Blunt and Republicans in the legislature cut the program severely in 2005, causing thousands of low-income parents and disabled persons to lose some or all of their benefits. To qualify for Medicaid now, a working parent can earn no more than 19 percent of the federal poverty level, an annual pay of just more than $4,000 for a family of four.
Nixon tried to increase the limits to 50 percent of the poverty level in 2009, but Republicans refused.
Now we have the federal Affordable Care Act, which calls for states to make Medicaid available to adults who earn up to 133 percent of the poverty level. The U.S. Supreme Court threw a wrinkle into the crinkly fabric earlier this year by making that requirement optional.
Missouri Republicans immediately declared that expanding Medicaid would be too costly, even though the federal government will pay 100 percent of the costs for the first three years, and not less than 90 percent after that.
They might have waited for some data. Studies make a convincing argument that getting more people on Medicaid would actually be good for Missouri’s bottom line. Federal money would come rolling in. Clinics would be built. People would be hired. The state would realize more tax revenue, and it would pay much less for services such as mental health treatment. Hospitals would be in a stronger financial position, and they’d be less inclined to charge private insurers more to recoup the costs of caring for uninsured patients.
True, the money to pay for the expansion would be taxpayer dollars. But as Nixon noted, Missourians pay federal taxes anyway. They might as well get back their share.
Against the concrete advantages of an expansion, GOP objections come across as vague and grasping. Mutterings about big-government and the creeping welfare state appeal to many in the Missouri electorate in theory. They may not work as well with cash and jobs on the table.
Already, the Missouri Chamber of Commerce, which works hand-in-hand with Republican legislators, has broken ranks and announced support for the expansion.
Republican legislators will hold out at a cost. The federal offer of full funding begins with the 2014 budget year — not when recalcitrant states decide to go along with the program. People who receive health insurance after going without are heavy users of services, scheduling surgeries and procedures they couldn’t afford before. States definitely want the federal government to pick up those expenses.
The secession petitions are a joke, but Missouri Republicans are serious about their revolt against Washington. In the end, though, it’s a no-win proposition. How about we skip it and have a pizza party?
To reach Barbara Shelly, call 816-234-4594 or send email to bshelly@kcstar.com.
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