Gov. Jay Nixon has made an expansion of Medicaid a high priority for this year’s session of the Missouri General Assembly, but local legislators of both major parties on Friday said it looks like a struggle.
“It’s very hard to see how we do anything with that this year with the way everything is working,” Rep. Mike Cierpiot, R-Lee’s Summit and assistant majority floor leader in the House, said at a gathering sponsored by the Independence Chamber of Commerce.
About 900,000 Missourians are on Medicaid, a program that provides health coverage mainly for mothers and children. Missouri took more than 100,000 people off the program in 2005 and has among the nation’s strictest requirements to qualify for it now. Under Obamacare, the federal government is offering states incentives to sign up more people, about 300,000 in Missouri’s case, starting Jan. 1, 2014. The Democratic governor wants that, but Republicans control the General Assembly and have come out against it.
“I’m really excited that the governor had championed that, and (it’s) in his budget,” said Sen. Paul LeVota, D-Independence.
The Independence chamber, like the Missouri Chamber of Commerce and Industry, has endorsed the expansion.
The argument to expand goes like this: Not only is the right thing to do morally, but it would help hospitals around the state. Those hospitals are set to lose significant federal money to offset their costs of uncompensated care – care they give now for many of the people who would come under Medicaid coverage. It’s how Washington, under Obamacare, sees hospitals coming out even or possibly ahead.
There is also an argument that bringing extra billions of federal dollars into the state would create jobs. A University of Missouri study conducted on behalf of the state’s hospitals says 24,000 jobs – including 4,200 jobs in five Kansas City metro counties – would be created. But Rep. Noel Torpey, R-Independence, said he doubts those figures.
“I don’t buy it, unfortunately,” he said.
Washington is offering to pick up almost all of the cost to expand – 100 percent of the expense for 2014 through 2016 and then scaling back to 90 percent by 2020 – but legislators expressed concern that over time Congress will whittle away at its share, as it has done with other programs in the past, despite promises to the contrary.
“So I understand the opposition to that,” said Rep. Ira Anders, D-Independence.
As legislative leaders are framing the issue now, the money has to come from somewhere and extra money for Medicaid would mean less for education.
“The problem is ... we have to figure out a way to pay for it. ... Right now, education’s going to pay for it, and that’s a problem,” Torpey said.
Cierpiot added: “It’s tough to put the poor against education, but that’s kind of the way it’s working.”
Page 2 of 2 - Legislators touched on other issues as well:
• Brandon Ellington, a Kansas City Democrat whose district includes parts of western Independence, said his focus in the legislature is on addressing poverty.
“When you’re talking about poverty, you’re talking about crime, you’re talking about education, you’re talking about economic development,” he said.
• LeVota said campaign contribution limits – the state currently has none – will likely either be dealt with in the General Assembly or will get to the ballot by initiative petition. Rep. John Mayfield, D-Independence, said he’s already filed a bill on that topic.
• Sen. Will Kraus, R-Lee’s Summit said Republicans are focused on a “BIG” – “build, invest, grow” – agenda that could include bonding for infrastructure improvements. A state commission recently suggested a major effort to find more money for roads and bridges and look at long-term projects such as rebuilding Interstate 70, which transportation officials describe as an increasingly urgent need.
That agenda also includes looking at tax rates, especially in response to tax cuts in Kansas, which Missouri leaders fear will mean the loss of more metro area companies to the Kansas side.
“They (Kansas) have done some significant things on taxes in the last few years,” Kraus said.
Anders suggested that Kansas is paying a steep price for companies – $300,000 in incentives per job, by one assessment – and said businesses look at more than taxes. A company moving from Kansas City to Johnson County, he said, might also be looking at the quality of schools.
“We are looking at a balanced approach when it comes to tax policy,” LeVota said.v