In a sign of the contentious fight likely to unfold during the upcoming legislative session, a planned meeting between Gov. Nixon and members of House and Senate Medicaid committees fell through because of disagreements over where to meet.
Rep. Jay Barnes and Sen. Gary Romine, chairs of the two committees, sent a letter to Nixon on Tuesday, requesting he visit a joint session of the two committees at the Capitol next week rather than meeting at the Governor's Office Building as Nixon initially proposed.
Barnes said he knew of no example of legislative committees meeting in Jefferson City outside the Capitol.
"This is a highly unusual request," Barnes said. "(Sen. Romine and I) believe the appropriate place to meet is the Capitol."
Nixon responded with a letter of his own, saying his office had already finalized details of the meeting by clearing the schedules of cabinet members who would participate, but he would not go to the Capitol.
"I was disappointed to learn today that you had reneged on our agreement for a constructive dialogue on this matter," Nixon's letter stated. "This last-minute change of heart demonstrates that... you and your leadership have chosen to give politics precedence over the substance of the discussion."
The two committees have met throughout the fall, hearing testimony about the state's current Medicaid system and discussing possible areas of reform, including expanding eligibility to all adults under 65 years old who are below 138 percent of the federal poverty line.
Medicaid expansion, which is allowed under the new health care law, would cover about 200,000 uninsured Missourians who cannot qualify for subsidies on the federal health insurance exchanges or Missouri current Medicaid system.
Throughout the hearings, Republicans have said they are wary of adding participants to a system that does not work as well as it could and have recommended reforms to improve coverage for those currently eligible. As of October, there were more than 850,000 Missourians enrolled in Medicaid.
During the House committee's final meeting Tuesday, one last proposal was put on the table. Rep. Keith Frederick, R-Rolla, expanded on his plan to create a pilot program that would provide current Medicaid population with health savings accounts that could be used to pay for an established relationship with a primary care physician.
Frederick's proposal would move up to 10 percent of current Medicaid recipients in between three and six pilot areas into a direct medical care model, which allows beneficiaries to contract directly with a primary care physician for about $80 per month. The patient has unlimited access to the physician and is able to reach them by phone, text or email to arrange next-day appointments.
Frederick, who is an orthopedic surgeon, also knocked managed care companies that currently administer Medicaid plans for beneficiaries in more than 50 counties as "mother may I medicine." He said he has had to wait on the phone in the past to see whether or not managed care plans would cover a particular service to his patient.
"(The direct medical care model) allows you to practice the way that you wanted to after leaving medical school... it lets you work with the patient to make decisions about their care," Frederick said.
Frederick invited Sonny Saggar, a doctor from St. Louis, to testify before the committee about how the plan would work.
The contracts can be with individual physicians or groups of doctors that provide a wider array of services; the more services that are covered by a direct medical care plan, the more the monthly rate would be. The plans would cover a variety of primary care and urgent care services and would help reduce unnecessary emergency room visits.
"There is no benefit to the physician in performing more tests or ordering more tests, the benefit is from keeping the patient healthy," Frederick said.
After the hearing, Barnes told reporters he was disappointed the meeting with the governor fell through, and said he would not participate in political theatre. Barnes indicated he had been in talks with the governor's office prior to Nixon's initial letter inviting the committee members to a meeting at his office.
"I've spent my summer doing this. I spent time last session doing this," Barnes said. "There is no one in the state of Missouri who has worked harder on the substance of this issue than me and that includes the governor."
Columbia Rep. Stephen Webber said he hoped political leaders could agree on a place for discussing an issue as important as Medicaid reform, but the specifics didn't matter to him.
"It doesn't matter what the forum is," Webber said. "I'll meet at a Pizza Hut if they want to meet at Pizza Hut. It doesn't matter to me."