State Rep. Noel Torpey, an Independence Republican, is putting forth a bill to change and expand the Medicaid program in Missouri, offering health insurance to the estimated 300,000 people in the state, including 40,000 in Jackson County, currently locked out of the system.

He acknowledged Friday that it’s a tough fight in the General Assembly.

“But I really believe we need to put the politics aside and look at policy,” Torpey said at a legislative update at the Independence Chamber of Commerce.

Gov. Jay Nixon, a Democrat, made expanding Medicaid one of his top priorities in 2013. The federal government is offering large incentives. It will pick up the full cost of added recipients for a few years before that tapers off to 90 percent permanently.

Under the Affordable Care Act, or Obamacare, expanding Medicaid is meant to fill a large gap where millions of Americans lack health insurance. About half of the states have taken Washington’s offer.

The Republican-controlled General Assembly did not act on Nixon’s request last year. Nixon and other expansion advocates say that means Missouri is missing out on $900 million from the federal government in 2014 alone. Nixon points out that means Missourian’s federal tax dollars are going to other states but not coming back here.

Torpey acknowledged that Obamacare is, in his words, “toxic” politically in much of Missouri but said the state has to act.

“However you feel about the Affordable Care Act – whether you love it or think its a train wreck – it’s here to stay,” he said.

Torpey pointed to disparities as things stand now in Missouri. A family of four, with a household income of up to $94,000, is eligible for subsidies on insurance purchased through health exchanges set up under the ACA.

“But a family making $20,000 can get no assistance at all,” he said.

Some of the bill’s specifics:

• Washington wants states to offer Medicaid to those making up to 138 percent of the federal poverty level. Torpey’s bill would raise that threshold to 100 percent and those between 100 and 138 percent could get insurance through health exchanges. “So it’ll cover everyone,” Torpey said. Iowa got a federal waiver for a similar approach.

• Recipients have to be working or looking for work, unless they’re students.

“If that’s not in there, that bill dies,” Torpey said.

• He said he will add a requirement that those newly enrolled in Medicaid attend a workshop or something similar to get up to speed on simple steps – going to a clinic instead the ER as a first resort, for example – that can save money and improve people’s health.

“Keep in mind it (the bill) is absolutely a work in progress,” he said.

Torpey pointed out that 74 percent of those on Medicaid currently are working. He said a typical person his bill would benefit is a mother with two kids, working a couple of part-time jobs, neither of which offers health insurance.

“We’re talking about people who are working people,” added Rep. Ira Anders, D-Independence.

Months of study

Anders and others commended Torpey for the work he’s done on the Medicaid question. Last summer, after the General Assembly’s 2013 session, he led a 50-member group – the Citizens and Legislators Working Group on Medicaid Eligibility and Reform – that held hearings in a half a dozen cities, including Independence. After that, he was vice chair of a second House group that also studied the issue.

Rep. John Mayfield, D-Independence, also was on the Citizens and Legislators Working Group, and he related a story from the meeting in Kennett, Mo.: A man with 22 years in local law enforcement is on dialysis. His wife is struggling for health benefits, and the state’s advice to her, Mayfield said, was to quit her job, divorce her husband – or both.

That, he said, is a failure on the part of the state.

“These are the real stories we hear across the state of Missouri,” Mayfield said.

Sen. Paul LeVota, D-Independence, has again introduced a bill to simply expand Medicaid along the lines Washington originally wanted: Open the program to everyone making up to 138 percent of the federal poverty level.

“That is the easiest and best way to expand Medicaid,” LeVota said Friday.

Also, advocates point to a new study by the Missouri Economic Research and Information Center that concludes simply expanding to the 138 percent level would bring the state $17.4 billion from the federal government between 2015 and 2022 and would add 23,800 jobs.

In Kansas City alone, that would mean 2,124 jobs, plus another 2,019 in Eastern Jackson County and eight nearby counties. MERIC also found that health care jobs pay better than the average job in every county in the state – 16.6 percent in Jackson County.

Torpey said he’ll shape his bill as needed as the current legislative session progresses. Legislators meet until mid-May. He said there are challenges.

“It’s an election year, and that complicates things,” he said. “I don’t like to say it, but it’s a long shot at best.”