Is Medicaid expansion right for Missouri?
Gov. Jay Nixon presented his supporting arguments during his State of State address Monday evening.
He characterized his support for Medicaid expansion as "right for Missouri," "the smart thing to do" and a "business decision."
Today, the case he presents is strong.
It weakens over the longer term - specifically in three years when $5.7 billion in federal funding for Missouri's Medicaid expansion is scheduled to end.
Nixon's plan would add 259,000 low-income, working Missourians to the Medicaid rolls.
The federal carrot is being dangled as part of the Affordable Care Act, also known as Obamacare.
The lure of federal money, however, is not the only factor driving Nixon's support.
The governor also characterized Medicaid expansion as a jobs program.
He referenced a University of Missouri estimate that the expansion would add 24,000 jobs in 2014. "We're talking about good jobs - for nurses, doctors, pharmacists, therapists and medical technicians."
He also cited support from business groups, including the Missouri Chamber of Commerce, Associated Industries of Missouri and a number of area chambers of commerce.
Support from these traditionally conservative associations for a tax-funded social service expansion proves the prospect of jobs may create unlikely alliances or, if you prefer, strange bedfellows.
Let us, however, look down the road - a view often anathema to government officials flush with federal funding.
What happens when the federal funding stops?
Nixon, to his credit, addressed that issue in his speech. He said: "I support a provision that rolls back the Medicaid expansion if Washington doesn't honor its commitment."
We believe such a provision - spelled out with specifics - is vital to any serious discussion about Medicaid expansion.
Reducing the Medicaid rolls in Missouri is not without precedent. In 2005, then Gov. Matt Blunt cut Medicaid - an action that pained previous recipients and generated significant criticism.
We caution against plunging into Medicaid expansion, particularly in the absence of a judicious exit strategy.