By David Lieb
JEFFERSON CITY – Gov. Jay Nixon renewed his push Tuesday to expand Missouri's Medicaid health care program to more lower-income adults, expressing hope that reluctant lawmakers will feel pressure to do so as other states start receiving a surge of federal Medicaid dollars.
The Democratic governor highlighted a Medicaid expansion as a priority for the 2014 legislative session, which starts next week. He also said he wants to boost spending on education and curtail some of Missouri's costliest tax credit programs.
Nixon similarly made Medicaid expansion a priority in 2013, but was rebuffed by a Republican-led Legislature that remains opposed to almost anything related to the federal health care law enacted by President Barack Obama.
Starting in 2014, states that expanded adult Medicaid eligibility can receive enhanced federal payments as part of Obama's plan to extend health care coverage to millions of uninsured Americans. Half of the states have chosen to expand Medicaid, including some that got federal permission to do so by subsidizing the purchase of private insurance policies or through other nontraditional means.
Nixon said $37 billion in federal aid will flow to 25 states that expanded Medicaid eligibility to an estimated 4.4 million people who work in "tough, low-paying jobs that don't offer health benefits." Meanwhile, nearly 300,000 Missourians who would have gained Medicaid coverage will remain without it, and Missouri will miss out on about $5 million of federal Medicaid money every day, Nixon said.
"It's no longer theoretical," Nixon said at a Capitol news conference in which he presented Medicaid expansion as a New Year's resolution. "It's real right now in so many states representing a wide diversity of our country."
Missouri's Medicaid program, called MO HealthNet, covers more than 850,000 people.
Nixon said businesses in other states that expanded Medicaid coverage will have a competitive advantage, because hospitals will have less of a need to recoup costs for treating the uninsured by charging higher rates to the insured. He said that could help hold down insurance premiums for those who get coverage through their employers.
"The rising of premiums, the lack of access to health care – those things will become more dramatic when our neighboring states are moving forward" with Medicaid expansion, Nixon said. Iowa, Illinois, Kentucky and Arkansas all are expanding Medicaid. Kansas is not.
The House and Senate each formed special committees to study Missouri's Medicaid program between the May conclusion of the past legislative session and the Jan. 8 start of the next session.
The Senate panel produced a report recommending a "transformation of the entire Medicaid program" before considering expanded eligibility. Republicans on the Senate committee specifically rejected a Democratic attempt to insert a recommendation in favor of a Medicaid expansion.
The House committee has yet to produce a report. But a Medicaid expansion appears to remain a longshot in both chambers.
"I think with the continued problems we see with the federal health care takeover – the Obamacare bill – a lot of people are very concerned about dumping billions of new state dollars into a system that appears to be more and more broken every day," House Speaker Tim Jones, R-Eureka, said earlier in December.
The House and Senate committees both studied potential Medicaid changes that would give incentives for patients to remain healthy and penalize them for going to the emergency room for minor issues that could have been treated more cheaply by a primary care physician. Both panels also have looked at expanding the use of managed care policies statewide.
Nixon said Tuesday that he's open to many of those ideas but wants them paired with expanded eligibility.
"Time is running short. We can, we will and we must get it done this year," Nixon said.
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