This article first appeared in the St. Louis Beacon: One week after discussing Medicaid expansion with House Republicans, Gov. Jay Nixon will sit down Tuesday morning with Republican members of the Missouri Senate to talk about the issue.
But the meeting may not go too smoothly. On Monday, the top Republican in the Missouri Senate indicated that Medicaid expansion may be dead for the session. And another senator told the Beacon in no uncertain terms that the Senate won’t approve either an expansion of the program to 138 percent of the federal poverty level or a Republican proposal that passed out of a state House committee last week.
In an interview with the Beacon, Senate President Pro Tem Tom Dempsey, R-St. Charles, said that Rep. Jay Barnes’ bill could get a “mixed” reception when it comes to the Senate.
“I would think that there would be great support for Medicaid reform,” Dempsey said. “It’s the expansion of the Medicaid rolls through private insurance that would run into some problems from some members of my caucus.”
Nixon’s office announced Monday that the governor would speak to “the majority caucus of the Senate about strengthening and reforming Medicaid.” Nixon, a Democrat, is planning to take questions from the capitol press corps around 10:30 a.m.
Nixon has been barnstorming the state trying to build support for expanding eligibility for Medicaid to 138 percent of the federal poverty level. He argues that move would spur economic development and save hospitals from the worst consequences of fewer federal dollars.
While Republicans have voted down expansion, Nixon had some kind words about legislation from Barnes, R-Jefferson City, that would substantially change how the program operates.
The bill – which passed out of the House Committee on Government Oversight and Accountibility last week -- would increase income eligibility for the program to 100 percent of the federal poverty level instead of the current 19 percent. But it would also reduce eligibility in other areas, including children's health care. 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. 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.
Last week, Nixon met with the House majority caucus to discuss Medicaid, and while he wasn’t content with the entire bill, Nixon told reporters in Kirkwood that Barnes’ bill is “a vehicle that can get this to the finish line.”
But the Senate is arguably the most powerful obstacle to getting anything done on the issue. That’s because a bloc of senators can slow legislation down – or kill it – if they object.
One problem, Dempsey said, is that attempts to pass legislation in 2008 and 2009 with eligibility changes to Medicaid were killed in the House. Some of the people responsible for that happening, he said, are now in the Missouri Senate, inclusing Sen. Rob Schaaf, aSt. Joseph Republican who adamantly opposes expanding Medicaid.
Dempsey predicted that the issue may not have a resolution by May 17 – the last day of the General Assembly’s session. It could be later this year or next session before this is resolved, he said.
“One of our objections is to the May 17 deadline – that this has to be completed by the end of session. As I discussed earlier, there’s much to still play out at the federal level,” he said. “Our concern – which I believe is justified – is what is going to be the long-term obligation of the state of Missouri? And I have grave concerns and I share those concerns that the rest of my caucus has.
“We’re going to be patient, we’re going to try to work through this and we’re going to make sure that we don’t get into ourselves in the situation where the state of Missouri is going to be on the hook for billions of dollars because the federal government can’t meet its obligations,” he added.
State Sen. John Lamping, R-Ladue, took things a step further. He told the Beacon on Monday that neither a conventional Medicaid expansion supported by Nixon nor Barnes’ bill would be taken up this year in the Senate.
“In 2013, the Senate is not going to take up HB700,” said Lamping, referring to Barnes’ bill. “It’s not going to pass its own reform bill. And the conversation has pretty much never started, [and is] pretty much over with respect to Medicaid expansion. I do think what the Senate will do upon adjournment is that we will begin the process of working in the offseason to craft our own very specific Medicaid reform bill. It will not involve any type of expansion. It will focus entirely on reform.”
While Nixon indicated last week that the legislature has plenty of time to pass something, Lamping contended that there’s no political momentum to change course.
“We’re done five weeks from Friday. It never started, but it’s over in the Senate,” Lamping said. “Like I said, you’ll see – we’ll formally announce that we’re going to focus on this and do a lot of good, hard work in the offseason and have a reform bill pre-filed.”
Earlier in March, the state Senate’s Republican leaders issued a joint statement declaring that they would not support an expansion of Medicaid.Among other things, the leaders indicated that they don’t trust the federal government to pay its share of the costs. Under the Affordable Care Act, the federal government is to pay all the costs of the Medicaid expansion for three years and then 90 percent thereafter.
Dempsey said on Monday that concerns expressed in that statement – and at other points before and during this year’s session – are still relevant.
“In our caucus, the prevailing thought is that as the federal administration gets closer to implementation, Obamacare is going to be a train wreck as far as trying to meet all the goals and promises that were made,” Dempsey said. “I think we saw the announcement last week where the exchange has been put off until 2015. So, we’re seeing the higher tax increases. But the aspects of the care that were supposed to make it affordable, that were supposed to provide for choice – all of those are being put off.
"And so we believe that the federal government is going to have to revisit the Affordable Care Act perhaps as early as later this year,” he added.
Nixon spokeswoman Channing Ansley said in an e-mail to the Beacon that Nixon "is encouraged by reform efforts underway in the House and looks forward to a productive discussion about the issue with the Senate Majority Caucus tomorrow."
"With full federal funding only available for the next three years, and federal cuts to providers taking effect next year, the legislature needs to move forward now to ensure the dollars Missourians send to Washington are spent here in Missouri -- not in other states," Ansley said in a statement.
