The Missouri House has passed a new state budget without Gov. Jay Nixon’s sought-after Medicaid expansion, but that doesn’t mean Republicans are dropping the issue entirely.
The House Government Oversight and Accountability Committee was slated to vote Wednesday on HB700, a bill proposed by state Rep. Jay Barnes, R-Jefferson City, to change the state’s current Medicaid program dramatically.
But word already is circulating that Barnes’ bill, even if it gets through the House, will have a tough time in the state Senate. Fellow Republicans and most Democrats oppose his plan. Meanwhile, Nixon is continuing to take his pro-Medicaid expansion tour on the road.
The federal government would pick up all the additional costs for the first three years, and cover at least 90 percent thereafter. So far, House Republicans haven’t embraced that plan, instead looking for other alternatives. Which is where Barnes’ proposal fits in.
The House oversight panel conducted a hearing last week on Barnes’ bill, which would result in dropping some people – including children – currently on the rolls and then adding others.
Barnes chairs the House committee and told The Beacon that his bill constitutes “a plan to fundamentally transform Medicaid system into the most market-based system not just in the entire country, but in the entire history of the program.”
Barnes said, “We are attempting to inject price competition into a system that for 45 years has been sorely lacking price competition.”
Among other things, Barnes’ bill would place income eligibility for the program at 100 percent of the federal poverty level. It would also reduce eligibility in other areas, including children’s health care.
The proposed poverty-line for eligibility is five times the state’s current limit (19 percent) for adult participation on Medicaid, but it’s less than the 138 percent required under the federal Affordable Care Act to receive federal money.
“The areas in which we’re reducing eligibility are populations that are going to have access to robust subsidies in a federal health-insurance exchange,” Barnes said. “So for example, a family of two making about $20,000 a year will have to pay about $34 a month for health insurance. That’s a reasonable cost for somebody to pick up.”
Barnes’ plan would provide state contracts to competing insurers and would give patients incentives to choose lower-costs plans.
The legislation is contingent on the federal government granting a waiver to Missouri, Barnes said. That’s important, because one of the tradeoffs of getting the enhanced federal funding is for states to raise the eligibility level to 138 percent of the federal poverty level.
“Either the federal government allows red states to craft solutions that work for them or we don’t do it,” Barnes said.
Joe Pierle, chief executive of the Missouri Primary Care Association – which backs the Medicaid expansion – said in a statement that Barnes’ bill “is the beginning of a process to bring much-needed stability and predictability to the state’s health-care system.”
Barnes’ bill, he said, “begins to build the framework for a Missouri solution to leverage our federal tax dollars to expand access to affordable health coverage for the working poor.”
Joan Bray – a former Missouri senator who is now the head of the Consumers Council – said in an e-mail to supporters that Barnes’ bill “would introduce a number of changes to the state’s Medicaid program but will never be implemented because the bill expands eligibility only to 100 percent of the federal poverty level.”
“Secretary Kathleen Sebelius of the Health and Human Services Department has made it clear that states will receive Medicaid reimbursement only if they provide service to people with incomes up to 138 percent of the federal poverty level – nothing less,” Bray said. “Without this, Missouri’s bill is meaningless.”
Asked about whether any proposal would have to expand Medicaid up to 138 percent of the federal poverty level, Nixon said, “138 percent is what the federal government says that it needs to have.”
“But there are lots of ways to get to 138,” Nixon said. “You could put some of these dollars through an exchange, for example, so folks would have a way to go on the marketplace. So the way Arkansas did it and the way some other states are doing it.”
Nixon was referring to how the federal government gave the green light to Arkansas’ plan to expand health-care coverage to low-income residents through insurance exchanges.
Nixon said Barnes’ bill represents “solid progress.”
That doesn’t mean Nixon is totally enamored with the proposal. In early March, he told reporters that he didn’t feel cutting children or pregnant women from the program were steps in the right direction.
The Columbia Daily Tribune reported that Senate President Pro Tem Tom Dempsey, R-St. Charles, said that Barnes’ bill would have a dim chance in the Missouri Senate.
Edited for length and reprinted with permission from stlbeacon.org.
