Missouri's Republican-led House dealt a resounding defeat Tuesday to Democratic attempts to expand Medicaid, refusing to add more than $900 million to the state budget to cover 260,000 lower-income adults because of concerns about a future drag on state finances.
The largely party-line votes against the Medicaid expansion marked the climax of a daylong House debate on Missouri's budget but were almost a foregone conclusion. That's because various Republican-led House and Senate committees have repeatedly voted down the Medicaid enlargement over the past several weeks.
On Tuesday, the House voted 104-50 against an amendment to add $890 million of federal funds to the proposed 2014 budget for the Department of Social Services to expand Medicaid coverage for adults. The House also voted 105-50 against an amendment to add nearly $54 million of federal Medicaid funds for mental health and senior services. In both cases, Rep. Chris Molendorp, an insurance agent from Belton, was the only Republican to support the Medicaid expansion. No Democrats opposed it.
Yet Tuesday's votes may not be the end of the debate.
Despite the Republican rejection, Democratic Gov. Jay Nixon continued to travel the state Tuesday trying to build public support for a Medicaid expansion as called for under the 2010 federal health care law signed by President Barack Obama. And a Missouri House committee is scheduled to vote next week on a Republican alternative that seeks to draw down the federal Medicaid money without adding as many adults to the rolls as envisioned by Obama. The GOP plan also would adopt a private-sector insurance model for Missouri's Medicaid program.
Missouri currently provides health care to nearly 880,000 people through Medicaid - about one of every seven residents.
A U.S. Supreme Court ruling last year gave states the option of rejecting a Medicaid expansion called for by the federal law but left in place a powerful financial incentive. States that expand coverage to adults earning up to 138 percent of the poverty level - about $32,500 annually for a family of four - can receive full federal funding for three years, starting in 2014. The federal share would gradually decline to 90 percent by 2020, with the states picking up the rest of the cost.
Democrats have pointed to studies predicting that the increased federal Medicaid money flowing to doctors, hospitals and other medical providers could spur creation of about 24,000 jobs while improving the health of lower-income working adults who currently lack insurance.
"This is a chance to give veterans, our sick, our needy, our poor access to health care and provide jobs to the rest of the citizens of this state using federal funds that we send to Washington" through taxes, said House Minority Leader Jake Hummel, D-St. Louis, who sponsored the amendments for the Medicaid expansion.
Republicans countered that the deficit-ridden federal government cannot afford the Medicaid expansion over the long-run and that the state's share of the costs eventually could consume money that otherwise go to public schools.
"If we do this, over the next 10 years, we will face a public education crisis," said Rep. Jeff Grisamore, R-Lee's Summit.
Rep. Jay Barnes, R-Jefferson City, said the Democratic health care plan would "build a Medicaid mansion on a crumbling foundation."
Barnes is sponsoring an alternative proposal that some Republicans are touting as a means of transforming Medicaid into a more market-driven insurance system. But it's unclear whether his proposal - still pending in a committee - will fare much better in the Legislature. House Speaker Tim Jones has said the debate about expanding or changing the Medicaid program could take two years to resolve.