A Missouri House committee heard public testimony Monday for a bill that would make fewer Missourians eligible for Medicaid and would allow those no longer eligible to qualify for subsidies within a state health exchange to help offset the costs of private insurance plans.
If passed, the Republican-led bill, sponsored by Rep. Jay Barnes, would be contingent upon several things - a waiver from the federal government to expand the managed care corridor from I-70 statewide, the price competition aspect of managed care, the federal allowance of increasing the state's Medicaid system to 100 percent of the federal poverty level and the federal government's adherence to its match promise.
"If the federal government attempts to pull the rug out from under us, we will not move forward," said Barnes, R-Jefferson City.
Barnes' bill would make Missourians up to 100 percent of the federal poverty level eligible for Medicaid. If eligible, a recipient will be presented with a list of at least three health insurance plans and their prices.
"No state, to my knowledge, has ever done this before," Barnes said. "If they (Missourians) pick the low-cost plan, they get to keep a portion of the savings to Missouri taxpayers. It's offering economic incentives to choose affordable care."
To qualify for incentives, Barnes said Missourians must not only pick the low-cost plan, they must also receive annual checkups from their physician.
Services covered under Barnes' Medicaid plan include ambulatory patient services, emergency services, hospitalization, maternity and newborn, mental health and substance use disorders, behavioral health, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness chronic disease management, pediatric services and any other service required by federal law.
The bill would increase Medicaid eligibility to foster care children, unborn children, healthy adults, parents and the medically frail. Barnes said it would decrease Medicaid eligibility to Blind Pension recipients, women with cancer, and children in the state's Children's Health Insurance Program (CHIP), with the exception of children of parents without employer-sponsored coverage or who have access to exchange subsidies.
Medicaid eligibility wouldn't change for pregnant women and infants. The program would eliminate the high-risk pool, the Ticket-to-Work program and the Uninsured Women's Health Services Program.
"These people who are eliminated will be eligible for robust subsidies in the exchange program," Barnes said.
Many of those who voiced their support for Barnes' bill in front of the House's Government Oversight and Accountability Committee on Monday also supported the Democrats' Medicaid bill that was rejected by a House committee last month. That bill fell in line with the plan outlined by ObamaCare, expanding Medicaid eligibility to 138 percent of the federal poverty level.
Supporters of Barnes' bill say they see the legislation as a unique opportunity.
"We should leverage these taxes to the federal government as a catalyst to reform our (health care) system," said Joe Pierle, director of the Missouri Primary Care Association.
John Orear, a volunteer with NAMI-Missouri and father of a son with bipolar disorder, said he supports reforming Missouri's health care system because he's seen his son struggle without insurance.
"This is life or death for these people," Orear said. "There are 80,000 people in the state with mental illness who won't have care without this. Let's put the politics aside. It's care for our kids."
Those who testified against Barnes' bill said they are opposed to Medicaid eligibility not reaching 138 percent of the federal poverty level and said the federal government won't approve the proposal because of that.
"Waivers will not be issued for up to 100 percent (of the federal poverty level) as a matter of law," said Sidney Watson, a professor at Saint Louis University School of Law. "This waiver will not be granted. It will take an act of Congress for the federal match to be reduced."
Barnes and supporters of the bill remain hopeful the Obama administration would approve the reform.
The House committee will hold executive session and vote on Barnes' bill, with amendments, some time next week.