Missouri Governor Pushes GOP-Led Legislature On Medicaid Expansion

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Missouri Gov. Jay Nixon, a Democrat, is intensifying his effort to persuade Republican lawmakers to expand Medicaid with a pitch that uses some of the same themes that Republicans favor.

At a news conference in his Capitol office this week, Nixon praised states such as Iowa and Arkansas for designing “common-sense, market-based approaches” that encourage personal responsibility on the part of Medicaid participants.

Those states “have seized this opportunity to implement innovative reforms, like rewards for making healthier lifestyle choices and penalties for missing doctors’ appointments or showing up at the emergency room with a stuffy nose,” Nixon said.

The governor and a coalition of business, labor and health care groups pushed during the last legislative session to expand Medicaid to the working poor, but the bill was shelved by the Republican-led Legislature. Critics said Medicaid is a broken, inefficient system and the federal government can’t be trusted to keep its promise to fund the expanded program.

Nixon said the dynamics will be different this year because the federal government will, in fact, be financing the expansion in states that accepted it. A recent study estimated that Missouri will turn away $2.2 billion in federal funds annually.

“As of 12:01 tonight … Missouri’s tax dollars are going to be used in New Jersey, Iowa, Arkansas and other parts of the country to solve their problems, and that’s not the way we like to do things in our state,” Nixon said.

Under the Affordable Care Act, the federal government will pay most of the cost to insure working-age people who make up to 138 percent of the federal poverty level, or $32,500 for a family of four.

Federal money will cover the tab for newly eligible participants the first three years, with states phasing in up to a 10 percent share of the cost after that.

Currently, Medicaid covers more than 875,000 Missourians — low-income seniors, people with disabilities and some families with children. Opponents say that even without expanding eligibility, the program’s cost to the state rises by $71 million a year.

“Missouri’s Medicaid system is already expanding at an unsustainable rate,” House Social Services Appropriations Chairwoman Sue Allen, R-Town and Country, wrote in a recent newsletter.

Whether Nixon and opponents can find any middle ground appears to be a long shot.

Rep. Jay Barnes, R-Jefferson City, drew up a proposal that would place people below the poverty level in the traditional Medicaid program and cover those making up to 138 percent of poverty by paying their premiums for private insurance.

But the House Interim Committee on Medicaid Transformation, which Barnes chairs, was cool to the idea and has not issued any recommendations.

So far, Nixon and legislators haven’t even been able to agree on a format for a joint brainstorming session.

Nixon invited House and Senate committees studying Medicaid to a round-table summit in November. But he canceled it after legislators decided to treat the meeting as a legislative hearing, where Nixon would testify and answer their questions.

“Governors don’t do that,” Nixon said testily in answer to a reporter’s question about why the summit fell through. “We wanted to have, and I still look forward to having, a thoughtful discussion. This is not a gotcha moment for either side.”