More than two dozen people testified in favor of legislation to expand Missouri's Medicaid program at a House committee hearing Tuesday, and more than 2,000 witness forms from across the state were added to the stack of supporters, while none voiced opposition.
But five Republican senators stood on the Senate floor Monday and spent most of their first hour back after the week-long spring break pouring cold water over hopes the General Assembly might be moving toward expansion, vowing to block any expansion legislation that reached their desk this session.
"There is no path for Medicaid expansion in the state of Missouri this year," Sen. Brad Lager, R-Savannah, said Monday.
The committee on Tuesday heard testimony on three bills that envision expanding eligibility requirements for people to access Medicaid coverage or subsidies for federal exchange plans to 138 percent of the federal poverty line. At that level, the federal government picks up at least 90 percent of the cost to cover new beneficiaries and 100 percent for the next two years.
One of the bills, sponsored by Rep. Noel Torpey, R-Independence, also includes a variety of reforms to increase accountability of those covered and price transparency for health care services. One of those provisions would require people on Medicaid to be working or searching for work and to pay for a portion of their coverage.
"The eligibility changes and the reforms are linked together if we truly want to get something passed this year and further down the road," Torpey said.
The Missouri Chamber of Commerce, the Missouri Hospital Association, doctors, faith leaders and activist groups all supported the expansion plans, but the most powerful testimony came from a handful of Missourians who make too much money to qualify for Medicaid but not enough to qualify for support to buy health plans on the federal exchange.
"Doctors tell me to apply for disability, so I can get insurance. But who at 29 years old wants to be disabled? I don't understand: I work, I go to school... what about those people who actually work?" said Jamie Kanan of Potosi, who works two jobs, raises her five kids and goes to college part time. Kanan said she needs back surgery, because her abusive ex-husband beat her, but she cannot afford it.
"If we put trust in these (lawmakers), I hope they will put trust in us," she said.
Jeri Landon, who is the sole wage-earner in a household with her disabled husband and adult daughter and is also a former cancer patient, said she forgoes regular screenings and fears her disease will return.
"I'm anxious about my health every day. If I get sick, who will take care of my family?" she asked the committee.
Todd Foltz of Gladstone told the lawmakers he suffers from multiple sclerosis and without insurance cannot afford the $5,000-per-month costs for medications to treat his disease.
"I fall squarely in the Medicaid gap, and for me it's becoming not just a gap but a crevasse, and it's becoming not just frightening but terrifying," he said.
Proponents argue expanding health coverage will help prevent worse diseases and higher medical bills from accruing, improve the overall health of the workforce, keep primary care physicians from leaving the state and is the moral thing to do. Heidi Miller, a primary care physician, told the committee she has hundreds of examples of patients who became sicker than necessary because they weren't insured.
"Do you know what happens when you have a broken arm and no orthopedist to fix it? The same thing that happened 1,000 years ago or in third world countries, you either die or it heals crookedly," Miller said. "You and your legislative partners can support my patients better than I can... none of my expertise comes to fruition if the meds are unaffordable."
Rep. Chris Kelly introduced a bill to expand eligibility under the current system but has said he also supports the reforms in Torpey's bill. He argued that Medicaid expansion and the federal dollars that would accompany it was good for the state budget. He pointed to the fiscal note on his bill that says expansion would increase state general revenue by nearly $50 million this budget year and $150 million next year.
"Here is the ironic thing, if any of us would isolate the amount of things that would come to our community... the amount of economic benefit that would accrue from this bill... (that representative) would be crowing from the rooftop," Kelly said.
Despite the wide support, Medicaid expansion faces stiff opposition in both of the Legislature's Republican-controlled chambers. House Speaker Tim Jones, R-Eureka, told The Associated Press there was little "appetite for (expansion) this year."
On Monday, Sen. John Lamping, R-Ladue, said there was a better chance of repealing the Affordable Care Act at the federal level than there was of expanding Medicaid at the state level.
"This is done, it's not happening, find something else to do, get on a plane and go convince the federal government to repeal Obamacare, because you have a better chance of getting that done," he said.