JEFFERSON CITY (AP) - Not waiting for President-elect Donald Trump to act first, some Missouri Republican lawmakers are pressing for a health care overhaul that could convert the state's Medicaid program into a block grant from the federal government.
A Republican-led Senate committee heard testimony Wednesday on legislation that would direct the state to seek a rarely granted "global waiver" from federal Medicaid requirements to reshape the state's health care program for the poor. The intent is to seek a block grant that would provide the state greater flexibility on how to spend it.
Trump, who pledged during the campaign to repeal President Barack Obama's health care law, has yet to put forth a detailed plan for how he wants to replace it. But he and some congressional Republicans have said they want to convert Medicaid into a block grant to states instead of reimbursing them on a matching basis for each dollar states spend. Such a plan could force all states to rethink how they administer their Medicaid programs.
Missouri Sen. David Sater said the state's more than $9 billion Medicaid program - called MO HealthNet - is beset by "runaway spending" and lacks "personal accountability and responsibility." Sater said he plans to bring his legislation up for a vote next week in the Senate Seniors, Families and Children Committee that he leads, which means it could be among the first batch of bills cleared for Senate debate this year.
If Trump and Congress later adopt a federal health care overhaul, Missouri could simply adjust to conform, he said.
"I would like to make this HealthNet program a better program as quickly as I can," Sater said.
His legislation seemed to have support from fellow Republicans on the committee, as well as the Missouri Hospital Association. But Democratic senators expressed concerns and nearly a dozen others testified against it, including advocates for the mentally ill, elderly, disabled and poor.
Jay Hardenbrook, a lobbyist for AARP Missouri, said he feared a block grant would create an incentive for the state to hold down costs by cutting services to those whose health care is the most expensive, such as older and disabled residents.
Only Vermont and Rhode Island previously received global waivers, said Sidney Watson, a professor at Saint Louis University's Center for Health Law Studies. She said the U.S. Department of Health and Human Services provided those states higher funding caps than they would have gotten using a straight federal match.
But Watson said there nonetheless "is more risk for the state" if its Medicaid costs exceed its federal block grant.
The Missouri legislation seeks to address that by requesting federal approval for the block grant to be adjusted for inflation, growth in the Medicaid rolls and other economic and demographic factors. It also seeks approval to potentially implement work requirements for able-bodied Medicaid enrollees and to require co-payments, premiums or health savings accounts for patients to "reward personal responsibility."
The bill gives the Legislature a role in overseeing the administrative process of rewriting the Medicaid program, which Sater said could take a couple of years.