A Republican legislator from Independence filed a Medicaid reform bill Tuesday that would expand eligibility requirements to 100 percent of the federal poverty line and provide premium assistance for people between 100 and 138 percent to buy plans on federal exchanges.
State Rep. Noel Torpey said Tuesday evening the bill included reforms that were discussed at length during interim hearings during the fall and that it was important for Missouri to live within the reality of the Affordable Care Act and make changes to it where possible.
The federal health care law allows states to expand Medicaid to 138 percent of the poverty line and receive substantial federal funds to pay for the newly covered populations. The federal government will cover 100 percent of the cost for the next two years and 90 percent beginning in 2022. About half of the states have elected to expand Medicaid, but Missouri has continued to hotly debate the issue.
"Whether you like the Affordable Care Act or hate it, it's the law," Torpey said. "It's not fair for Missourians to deal with (the law) as it is. We should make changes to it for Missourians."
Reforms in Torpey's bill include increasing the transparency of pricing for health services, rewarding good health behavior by eliminating some copays for people who do not abuse emergency room services, and penalizing people a percentage of their income if they continued to practice poor health behaviors.
"We want people to do preventive medicine," he said. "We are rewarding good behavior and punishing bad behavior."
He said it was not fair to give tax credits to people at 300 percent of the poverty line, as is provided in the federal law, but not help someone at 80 percent of the poverty line.
Gov. Jay Nixon and Democratic lawmakers have made expanding Medicaid a top priority, arguing it would cover nearly 300,000 uninsured Missourians, but House and Senate Republicans have continued to balk at expansion, instead calling for reforms to the currently eligible populations.
In the Senate, an amendment to expand eligibility to 138 percent of the poverty line was voted down 23-9 along party lines earlier this session. Sen. Rob Schaaf and Rep. Keith Frederick, who both served on the interim committees that discussed Medicaid, filed companion bills last week that would add more transparency requirements for pricing of health services among other changes, but would not change eligibility.
Torpey recognized that some of his Republican colleagues will be a tough sell on expansion, but said he thinks it's an important discussion to have. "If there is great pushback in a particular area, we can make changes. It's a starting point, and it's important to have the conversation, because (the law) is not going away."
Rep. Jay Barnes, R-Jefferson City, is a co-sponsor on the bill and has pushed his colleagues to consider expanding eligibility since last session, and Torpey hopes the number of supporters will grow as the bill makes it way through the process.
"Hopefully, when people start looking at and talking about it, they will feel more comfortable to co-sponsor - on both sides of the aisle," Torpey said.