Rep. Jay Barnes, R-Jefferson City, rolled out budget projections Wednesday for a Medicaid expansion plan he says would increase state general revenue by $42 million in 2021.
Skeptical House committee members - especially fellow Republicans - grilled Barnes about his calculations and the politics of moving legislation forward. They said he didn't include in his estimates increased administrative costs or take into account larger philosophical concerns about the nation's fiscal stability.
Barnes' plan, which he said was a framework for discussion and not his final proposal, would extend Medicaid benefits to adults at or below 100 percent of the federal poverty line and subsidize private plans for adults between 101 and 138 percent of poverty. The plan would also trim the state's Children's Health Insurance Program, which covers children up to 300 percent of poverty.
"I'm comfortable saying families that make 300 percent of the poverty line should buy health insurance for their kids," said Barnes, who chairs the House committee. "I might be on an island, ... but I'm willing to throw myself out there and get beat up from the left and right."
The parents of children who would be moved off of the CHIP program could afford subsidized plans on the new federal health exchange that in many instances would be the same price as premiums families already pay for CHIP and would provide coverage for the entire family, Barnes said.
Other savings included transferring participants from other
existing programs into subsidized exchange plans, reductions in blind medical benefits, expanding managed care and home health programs, eliminating the state's high risk insurance pool as well as savings generated from diverting drug users to treatment rather than incarceration.
Some committee members said cutting coverage of children could be tough, and representatives from children's hospitals also expressed skepticism. Barnes' budget totals estimated the savings from CHIP to be about $5 million in 2021.
"It bothers me that we are looking to help children and pregnant women but only on the backs of those kids and future kids. ... As a nation, it's putting concrete shoes on future generations," said Rep. Keith Frederick, R-Rolla.
Republican Reps. Sue Allen, Town & Country, and Marsha Haefner, St. Louis, said they still think the committee should focus on improving the current system and look for potential savings there before considering expanding eligibility requirements.
"We should identify where there are savings under the current system and that should be job No. 1 of the committee - to identify those and make those savings," Haefner said.
Chris Kelly, D-Columbia, defended the numbers and challenged other members to present budget projections as detailed as Barnes' plan.
"(Committee members) are trying to change the subject away from the irreducible fact that expansion saves the state money," Kelly said.
Rep. David Wood, R-Versailles, said expansion would create jobs because there would be a need for more health care providers. "Having more people with benefits will have a positive economic benefit in my view."
Emmy McClelland, government relations director at Children's Hospital in St. Louis, told the committee she would not support the CHIP reductions, arguing the program saves money for the state over the long term.
"I think you have to go back and look at these kids. It's going to be really, really hard to get savings out of this group," she said. "It's small dollars that correct problems at a young age and save large dollars when these kids become adults on Medicaid or Medicare."
After the committee finished for the day, Rep. Stephen Webber, D-Columbia, said he was pleased with the framework Barnes had presented.
"The most productive thing was to lay out very specifically how expanding Medicaid saves the states tens of millions of dollars," Webber said. "My preference would be straight Medicaid expansion, but I'm open to different and creative ideas to expand."
But Webber warned that the General Assembly should not get too creative or risk the federal government rejecting a final plan.
"To the extent that we can stick to what other states have had waivers approved for, the better chance we can get one," he said. "It's very possible if we push too hard, (the federal government) will reject a waiver."
Barnes expects the federal government to provide leeway for how Missouri reshapes its Medicaid program. "The Obama administration claims it wants to be flexible. It's going to have to be flexible - end of story."
Webber said he thinks the committee is nearing the end of its work and in the upcoming session it would be time for lawmakers to go on the record with where they stand.
"The issue has been examined and reviewed; it's time to finalize proposals and vote on them," he said.
The committee, which has heard many hours of testimony from dozens of witnesses, will hold its final meeting Nov. 19. Barnes implored other members to bring alternative budget projections if they didn't agree with his. After the final meeting, Barnes will go about summarizing testimony into a draft report to share with other members.
Gov. Jay Nixon sent a letter on Tuesday to members of the House committee and a similar Senate committee, inviting them to a discussion of Medicaid issues on Nov. 26.