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Government, Politics & Issues

Missouri Republicans see political opening in fight against Affordable Care Act

This article first appeared in the St. Louis Beacon. - Missouri Republicans in Washington and Jefferson City are standing firm in their opposition to the Affordable Care Act. They are citing the low number of Missourians who have signed up for insurance on the federal exchange as just another reason why their stance hasn’t changed -- and won't.

Meanwhile, this week at least, Missouri Gov. Jay Nixon appeared to be the state’s most vocal Democrat pushing back.

In federal and state capitals, the GOP has been particularly vocal this week. After being battered by the shutdown, Republicans see a great political opening for themselves because of the problems with the website for the insurance exchanges and the cancelation of millions of health insurance policies  because they don't meet ACA standards.

The Republican message boils down to two points: Obamacare is messed up and not worth saving.

Although many health-care groups and Democrats disagree, the GOP's success in publicly driving home that message  -- as shown in recent polls -- is credited with the decision of 39 U.S. House Democrats to break ranks on Friday and join Republicans in passing a House health-care bill that has no chance of passing the Senate and which President Barack Obama has promised to veto.

Those Democratic defections are seen as proof that the Democrats and the president are on the politically defensive -- which can, in turn, affect policy.

U.S. Sen. Roy Blunt, R-Mo., told reporters during Thursday’s conference call that he expected the troubled federal website that handles the exchanges to be fixed eventually. So unlike other top Missouri Republicans, Blunt dwelled little on the 751 Missourians who have applied for coverage on the site so far.

Instead, the senator emphasized that his objections to the ACA centered on its provisions, not the website.

Among other things, Blunt has hammered for days – in news releases and on the Senate floor-- at the individual insurance company cancellations.

Blunt told reporters Thursday that he wasn’t assuaged by President Barack Obama’s announcement that he was using an executive order to grant insurance companies permission to extend those policies for another year.  The order likely won’t extend many policies, Blunt said, but instead reflects that “the president is clearly trying to deal with the public’s broad dissatisfaction.”

The bill that passed the House on Friday would also allow insurance companies to sell new individual polices that don't meet the ACA standards.

Both parties agree that the bill, and Obama's order, aren't likely to affect many policies because insurance companies have always had the power to cancel or change policies annually -- regardless of the ACA mandates, or the wishes of the policy holder.

The so-called fixes being considered in the U.S. House and Senate wouldn’t curb the insurance companies’ power to cancel policies, change coverage or their networks of physicians and hospitals.

Blunt acknowledged as much. “That’s not unusual,’’ Blunt said, referring to annual policy cancellations. “But I’m not the one who said, ‘If you like your plan, you can keep it.’ That was a major selling point.”

In effect, Republicans are focusing more on what the president said, than what he did.

Blunt reaffirmed that he continued to believe that state “high-risk pools’’ were the best ways to offer coverage for people denied insurance because of pre-existing conditions. About 4,300 in Missouri used that coverage, which was expensive. But Blunt said his staff had heard from some that they still preferred the pool’s coverage to what they could obtain under the ACA.

U. S. Sen. Claire McCaskill, D-Mo., continued to focus primarily on the troubled federal website. "The initial enrollment numbers are disappointing, and the problems with the online marketplace are unacceptable and embarrassing,'' she said in a statement late Thursday. "What’s happened is this free market system has opened for business, but the front door remains locked....We need to really focus on improving the website, and I’m going to be part of any effort to do that."

Missouri Republicans in the U.S. House -- notably U.S. Reps. Ann Wagner of Ballwin and Blaine Luetkemeyer of St. Elizabeth -- also continued pounding this week on the cancelled insurance policies and public complaints that the alternatives were more expensive.

Back in Missouri, opposition to Medicaid expansion shows no sign of softening. State House Budget chairman Rick Stream, R-Kirkwood, gave three reasons Republicans in the state Capitol continue to oppose any expansion of the state’s Medicaid program, as sought by the ACA. Such expansion is optional, as a result of the 2012 U.S. Supreme Court ruling.

During the recording of the Politically Speaking podcast (a joint venture involving the Beacon and St. Louis Public Radio), Stream said that many Republicans object to offering Medicaid to “able-bodied people.”

The GOP also opposes any expansion in federal spending because of the national debt, he said. And finally, Stream noted that many Republicans were elected in 2010 and 2012 because of their opposition to the ACA. Their supporters may see any change in their positions as a betrayal, he added.

Stream sits on a House committee that held hearings this summer on the Medicaid issue. On Wednesday, the Senate Interim Committee on Medicaid Transformation and Reform voted against including any Medicaid expansion in its legislative recommendations.  The Democrats on the panel walked out in protest, although they returned for the final vote.

State Sen. Jamilah Nasheed, D-St. Louis, said the protest reflected the fact that “the majority of the public testimony’’ during the summer’s hearings favored Medicaid expansion.

“I can’t believe how heartless some people can be,’’ she added.

Nixon offered a similar assessment during a news conference Thursday morning in St. Louis on a variety of issues. “The Senate report, he said, “didn’t reflect what Missourians were saying at the hearings…I do find it interesting that one of their conclusions was that we needed to expand dental coverage.”

“I look forward to talking to both committees’’ on Nov. 26, at a meeting he has scheduled to discuss health care.

Nixon said the low number of Missourians getting coverage on the federal exchange’s website “continues to prove each and every day that we should be making these choices in Missouri.”

Nixon was referring, in part, to the decision of the GOP-controlled General Assembly not to set up a state insurance exchange, relying instead on the federal site. “Whether it’s on the exchange or working people’s health care, we do a lot better job in the Show Me State than they do in Washington, D.C.,“ he said.

Nixon previously has noted that his administration has been hampered by the 2012 passage of Proposition E, which barred the creation of a state exchange without a vote of the public or the General Assembly. The proposition also restricted state involvement in promoting the federal exchange.

“Standing mute and standing away from it is not a solution,” Nixon said. “We would be better served if legislators and other policy makers embrace the challenge to improve the system.”

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