GOP-controlled House blocks multiple attempts at Medicaid expansion

Democrats had proposed the federal Medicaid dollars in amendments to the budget bills for the fiscal year that begins July 1.

The nearly $25 billion budget plan was approved after about six hours of debate that largely centered on Democrats’ plans to add nearly $900 million in federal dollars to get an estimated 200,000 more people on Missouri’s Medicaid rolls.

“We all know that Medicaid is the signature issue of this body - of both chambers - this year,” said House Minority Leader Jake Hummel, D-St. Louis. “It’s right for job creation. It’s right for the citizens of this state.”

But Republicans in the chamber repeated their concerns – that expansion will add too much of a burden to federal expenses, that the federal government can’t be counted on to hold up its end of the expansion plan and that, ultimately, an expansion could create a burden on other areas of the state budget, including education.

“While some of us would say, ‘Let’s just sunset the bill,’ I don’t think it’s the right decision to give Missourians health insurance for three years and then yank it out from them,” said Rep. Caleb Rowden, R-Columbia.

For their part, House Republicans have been pushing alternative efforts that include Medicaid reforms, but the only incarnation of that, a proposal sponsored by Rep. Jay Barnes, R-Jefferson City, was not counted in the budget bills approved today.

“Let’s reform this,” said Rep. Kevin Engler, R-Farmington. “Why expand a system that’s broken?”

Under the federal Affordable Care Act, states can expand Medicaid, a joint state/federal program that provides health care coverage for the poor, to more people and the federal government will pick up most of the costs

The proposal, which has been championed by Democratic Gov. Jay Nixon and health care and business groups in Missouri, would set eligibility at 138 percent of the poverty level, or about $32,500 for a family of four or $15,800 for a single person.

About 880,000 Missourians are enrolled in Medicaid, which has varying degrees of coverage based on income. Childless adults who are not disabled or elderly can’t qualify, so they would be the largest group to benefit from an expansion.

But Republicans long have complained that the system is plagued with waste and fraud.

During the House debates on the issue Tuesday, Democrats tried to push for expansion and reforms.

“The immediate question is about funding,” said Rep. Kevin McManus, D-Kansas City. “We should be embracing this op to make changes to the system to improve the system and use federal dollars to do so.”

Democrats also argued that rural hospitals and others will be negatively impacted by other areas of the Affordable Care Act, including the loss of disproportionate share hospital payments, if the state doesn’t agree to expand Medicaid. But several Republicans balked at those claims.

“The president of the United States is holding our hospitals hostage,” said Rep. Wanda Brown, R-Lincoln. “Republicans didn’t do this; the president of the United States did this.”