Legislation that would expand Medicaid and create a state health exchange passed a House committee Wednesday, even though it would expand Medicaid for up to 100 percent of the federal poverty level, not the 138 percent required by federal law in order to receive full federal funding for expansion.
The bill, sponsored by Rep. Jay Barnes, R-Jefferson City, passed the House Government Oversight and Accountability committee 7-2. It would make fewer Missourians eligible for Medicaid and allow those no longer eligible to qualify for
subsidies within a state health exchange to help offset the costs of private insurance plans.
"If you look at the bill, you see that it injects price competition for the first time in the entire history of the federal program," Barnes said. "It expands private insurance and turns Medicaid recipients into participants for the first time in Missouri.
"This doesn't look like any Medicaid program any state has ever had."
Through the exchange, a recipient would be presented with a list of health insurance plans and if they choose the low-cost one, they get to keep a portion of the savings to Missouri taxpayers.
Although seven members of the committee voted in favor of the bill, several of them said they have doubts about certain provisions.
"I will vote in support to get it through committee and address the issues at a later time," said Rep. Gina Mitten, D-St. Louis.
One of the biggest doubts about the bill is that it would make Missourians up to 100 percent of the federal poverty level eligible for Medicaid. In order to get full federal funding for the Medicaid expansion through the Affordable Care Act, up to 138 percent of the federal poverty level must be eligible for Medicaid.
Rep. Kevin McManus, D-Kansas City, voted against the bill because he doesn't think that it will be implemented as written.
"I think we need to raise eligibility standards and I don't see that being resolved in this bill," he said. "I think it's a step in the right direction, but we have a long way to go with it."
Barnes believes the federal government will match funding for 100 percent of the federal poverty level. He thinks the issue is that no state has yet presented a plan like it.
"No state has put legislation on the table," Barnes said. "The test has not been put out there. I think the Obama Administration needs to show flexibility because this is a complicated product."
Even though it passed through committee Wednesday, another House committee must approve Barnes' legislation before it reaches the full chamber.
"It's the opportunity to give Missouri the most market-based system in the country and serve as a model to states across the country to save money," Barnes said. "People should seriously consider it.
"Obviously, I'm voting for it and I think everyone who looks at it should."