Missouri's flawed plan for Medicaid expansion
The Kansas City Star
Republicans who control the Missouri General Assembly have said any expansion of Medicaid eligibility to serve more low-income families would have to be done “the Missouri way.”
A bill introduced this week in the House gives some indication of what that might involve. Unfortunately, much of “the Missouri way,” as outlined by GOP Rep. Jay Barnes, is the wrong way.
The federal Affordable Care Act calls for states to expand Medicaid eligibility to 133 percent of the poverty level, with Washington picking up all of the tab for three years and never less than 90 percent after that. The expansion is optional, but states that don’t participate will miss out on an influx of federal funding.
Gov. Jay Nixon and fellow Democrats in the legislature are solidly behind expanded limits, noting correctly that they would provide an economic boost and bring medical security to thousands of Missourians.
The bill introduced by Barnes, a Republican from Jefferson City, expands Medicaid limits for adults, but only to 100 percent of the poverty level. That would likely rule out the state receiving any added federal funds.
Worse, Barnes’ bill lowers the eligibility threshold for children and pregnant women, who currently qualify for Medicaid at income levels above the federal poverty level.
Others who would stand to lose health insurance under the new proposal include some blind Missourians currently covered by the blind pension fund, and uninsured patients with breast and cervical cancer.
Barnes’ legislation assumes children, pregnant women and other with incomes slightly above the poverty level would qualify for federal subsidies to purchase private insurance through a statewide exchange. But that would likely cost more than pulling them into the Medicaid program.
Barnes describes his bill as “market-based Medicaid,” and some of its provisions are smart and innovative. He wants to reward Medicaid recipients for using less costly forms of care and medications, for instance. He also would expand managed care and promote competition among providers.
But the bill’s merits are overwhelmed by its flaws. Barnes’ proposal wouldn’t provide the economic stimulus that would come with a full expansion. It would still leave hospitals to pay for uncompensated care. And yanking health insurance from an estimated 44,000 children is simply wrong.