Missouri Gov. Jay Nixon renewed his support of expanding Medicaid on Tuesday night during his State of the State address, but Republicans remain strident that reforms to the current system are necessary before expansion can be considered.
The governor's plan was greeted by the Republican-dominated General Assembly with a smattering of applause from the right side of the aisle and a standing ovation from the left and in the public galleries.
"The most significant improvement we could make to health and well-being of our state is Medicaid, and it needs to get done this year," Nixon said.
Nixon pointed to states that have accepted the federal funds provided by the Affordable Care Act to expand Medicaid eligibility to 138 percent of the federal poverty line, and said they were receiving more than $5 million a day of Missouri tax dollars to implement their new programs.
"Each day we don't act, these states use Missourians' tax dollars to implement innovative reforms, like rewards for making healthier lifestyle choices and penalties for missing doctors' appointments," he said.
But Republicans in the Legislature continued to call for reforms to the current system before they would be willing to consider expanding the number of beneficiaries.
Sen. Gary Romine, R-Farmington, who led an interim committee on Medicaid reform during the fall and has introduced legislation that would put some of those reforms into law but not expand eligibility, said changes to the current system were necessary before legislators could "start the dialogue" on expanding eligibility.
"Our focus has got to be on the reforms," Romine said "No way I can beat the (expansion) arguments with my colleagues until we have a system we are comfortable with... It comes down to what is sustainable and what is good for our state."
Other Republicans raised the philosophical concerns of accepting federal money that is driving the nation deeper into debt.
"The problem that we've had with Medicaid expansion has been (the state) having an even stronger relationship with the (federal) government, when all they know how to do is borrow money," said Senate President Pro Tem Tom Dempsey, R-St. Charles.
"So, it's not just tomorrow or one year from now - it's how do the policies that we're pursuing affect us five, 10 years and beyond?" Dempsey said.
Rep. Jay Barnes, R-Jefferson City, who led the House's interim Medicaid committee, which never released a final report, said he would not introduce Medicaid legislation but expected other members would soon file reform bills.
Barnes was one of the few Republicans that applauded during the governor's call for expansion to Medicaid.
"I heard him talking about Medicaid reform and dealing with eligibility," Barnes said. "I didn't hear anything out of the governor tonight that surprised me (on Medicaid)."
The governor included Medicaid expansion in the budget he released Tuesday evening - it assumed $1.7 billion in federal funds and general revenue savings of more than $77 million from moving beneficiaries who are currently served by the state into the federal program. Nixon and his budget director Linda Luebbering predicted that 297,000 new beneficiaries would be covered in the next fiscal year if Missouri expanded its program.
Luebbering said the number of new beneficiaries assumed take-up rates of 70 to 75 percent for average uninsured citizens and rates of up to 95 percent for the more severely disabled individuals with more significant health needs. The governor's budget also included savings from additional care coordination, expansion of the state's health homes project and expanded fraud protection efforts.
She said the newly eligible beneficiaries under expansion would be covered by care coordination models and not a fee-for-service.
Nixon used the speech to knock the rollout of the federal law - "Obamacare" he called it, receiving hoots and hollers from Republicans on the House floor - but he also said refusing to accept the federal Medicaid dollars would do nothing to improve the law's problems.
After the speech, the Missouri Hospital Association and the Missouri Health Advocacy Alliance applauded Nixon for once again calling to expand Medicaid and argued it would bring new dollars into the state and provide more people with much-needed health care.
Links:
Gov. Nixon's proposed fiscal year 2015 budget
Archived video of Nixon's speech
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