Gov. Jay Nixon observed the nation's income tax deadline day Tuesday by arguing, again, that Missouri lawmakers are hurting the state's economy with their refusal to expand Medicaid, as envisioned by the federal health care law.
But Senate Appropriations Chairman Kurt Schaefer, R-Columbia, again accused the governor of using a false argument, because Medicaid payments don't work the way Nixon says they do.
The latest comments continue a debate that's been raging for several years.
Although the U.S. Supreme Court ruled in 2012 that Congress has the authority to require people to have a minimum level of health care coverage, the nine-judge high court said Congress only could support an expansion of the Medicaid system, not require each state to make the expansion.
The Patient Protection and Affordable Care Act, which President Obama signed into law on March 23, 2010, says the federal government will pay 100 percent of a state's costs for raising the Medicaid eligibility guidelines to 133 percent of the national poverty level, for the first three years - then pay 90 percent of those costs in future years.
This is the second year of the plan.
Nixon has included expansion as part of his proposed budgets the past few years, arguing it will help improve Missouri's economy in a number of ways, including nearly 24,000 new jobs, $9.9 billion in new wages and $402 million in new state general revenue from 2015-22 - with $53 million next year, alone.
Since last year, the governor's message also has included an argument that failure to increase Medicaid in Missouri means taxpayers' money goes to other states that have expanded their programs.
But, Schaefer said in an interview: "The way the Medicaid program works, there's a formula based on eligible population in the state, certain economic indicators in the state, how much of a match you get from the federal government - basically, the amount of money that a state gets in federal match money from the federal government is solely dependent on those factors.
"So, whether the state of Florida does expansion or doesn't do expansion has no bearing on Missouri, or vice versa."
In Tuesday's news release, the governor's office said: "As a result of the state legislature's refusal to strengthen and reform Medicaid, Missouri taxpayers have now spent $574 million to expand and improve health care in other states since January 1st."
The release also promoted a new website, www.MO.gov/WePaidForIt, "which includes a map of bipartisan reform and expansion efforts in states across the country."
According to that interactive map, Missourians' taxes have paid $1,973.5 million total to help 25 states expand their Medicaid programs by 5.595 million people - including $340 million helping an additional 964,000 people in Arkansas, Kentucky, Illinois and Iowa, the four neighboring states with Medicaid expansion.
"The factors are what they are and, if you meet the factors, you get x-amount of money," Schaefer said, "and it is in no way dependent on what other states do. It's completely independent of that."
Still, Nixon charged that with a month left in the session, "it's time for the General Assembly to protect taxpayers and bring affordable health coverage to working families in Missouri by strengthening and expanding Medicaid the Missouri way.
"Let's stop paying for health care in other states and start reforming it in ours."
In several different Senate debates this year, Schaefer has pointed to Medicaid's continuing growth in Missouri - even without adding 300,000 more eligible people under the expansion proposed by the Affordable Care law.
"More people being eligible is called "caseload growth,' and things getting more expensive every year for the same services is, simply, called "costs to continue,'" he said Tuesday afternoon.
"And those two factors have caused the existing Medicaid program, without expansion - completely independent of expansion - to grow by over $980 million of general revenue in the last five years."