Former Republican U.S. Sen. Kit Bond is taking a novel approach while lobbying skeptical GOP lawmakers to expand Medicaid coverage for the working poor.
His message: The federal health care law enacted by President Barack Obama is so "devastating" that - instead of rejecting it - Missouri should embrace one of its key provisions.
Bond, who now is lobbying for the Missouri Chamber of Commerce and Industry, sought to make the case Tuesday that reluctant GOP state lawmakers should expand Medicaid coverage as a means of drawing down billions of additional federal dollars. He said that would offset federal funding cuts hitting hospitals as a result of separate provisions in the health care law.
"The Obamacare cuts are the greatest threat to our health care safety net I've seen in my career," Bond said at a forum sponsored by the Chamber of Commerce. "The only way to confront these costly cuts is to pass a commonsense Missouri reform and solution."
Missouri's Medicaid program currently covers about 840,000 people, the majority of which are children. Obama's health care law encourages states to expand eligibility to adults earning up to 138 percent of the poverty level - or nearly $33,000 for a family of four - by initially providing full funding for those adults and then gradually requiring a 10 percent state share.
Because the federal law assumes more people will gain health insurance, it reduces the amount of federal money paid to hospitals for treating the uninsured. It also reduces the annual growth rate of federal Medicare reimbursements for treating seniors and the disabled. As a result of those changes, Missouri hospitals are projected to see a $456 million funding reduction in 2016 that rises to an $877 million loss by 2019.
About half of the states have expanded Medicaid coverage for lower-income adults. But Missouri's Republican-led Legislature has repeatedly defeated expansion, citing general opposition to Obama's health care law and concerns that an enlarged Medicaid program could eventually become costly to the state.
Bond voted against the federal health care law when it passed in 2010 and chose not to seek re-election that year.
He said Tuesday that Missouri could stockpile savings generated from the initial years of a Medicaid expansion to help cover any potential future costs to the state. He said some of the new adults could be covered by using federal Medicaid dollars to purchase private health insurance policies. And Bond said legislators could revamp Medicaid by requiring participants to pay more out of pocket and offering incentives for healthy behaviors.
"This is not Obamacare - this is the Missouri solution that will help counter the devastating impacts of Obamacare," Bond said.
A bill by Republican Rep. Noel Torpey, of Independence, proposes some of the Medicaid changes backed by Bond. It would expand eligibility to the levels necessary to receive enhanced federal funding and would use the money to buy private health insurance policies for some of the participants, which would require federal approval. The bill also would require some people to work to be covered.
Torpey's legislation has yet to receive a House committee hearing. Bond acknowledged that lobbyists supporting the Medicaid plan have a challenging job.
"Do we have all the votes now? No. But we've got a significant number who are working on the process," Bond told reporters. "There will be, as the session develops, a significant group coming forward" to support Medicaid legislation.