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The Republican candidates for the 59th District Missouri House of Representatives seat generally agree that expanding Medicaid in the Show-Me State isn't a good idea.

When Congress passed the "Patient Protection and Affordable Care Act" in 2010, one of its key provisions was providing more health care to people who didn't have coverage by expanding the number of people eligible for Medicaid to 133 percent of the federal poverty level.

Medicaid always has been a joint venture between the federal government and the states, with a set of federal rules and payments as well as state payments and, sometimes, individual state rules modifications.

To make the expansion proposal more attractive, the 2010 federal law — popularly known as Obamacare — said the federal government would pay 90 percent of the states' increased costs for adding people to the lists of those who qualified for the financial assistance.

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When the U.S. Supreme Court, in a 5-4 decision in 2012, upheld the law as a whole, it said each state could decide to accept or reject Medicaid expansion.

Missouri lawmakers, so far, have rejected the idea.

"Anything we do in Medicaid must be fiscally responsible, and not a large burden on the taxpayers," Karen Leydens, of Jefferson City, told the News Tribune. "The other thing is, federal money is not always a guarantee. And we need to make sure that any expansion doesn't diminish care for the most vulnerable who are, already, on Medicaid."

Rudy Veit, of Wardsville, said: "Affordable health care for everyone is a commendable goal — promising it is dishonest."

With "far too many Medicaid dollars" wasted on bureaucracy," Veit added, the state should start streamlining services to improve Medicaid's effectiveness. If Medicaid is streamlined enough, we have additional money that we should expand to cover those additional areas, but I don't think that the public as a whole is willing to pay more taxes or to expand Medicaid."

Randy Dinwiddie, of Olean, said government "is not the answer to health care" in the first place.

"Preventative measures and teaching patients what causes their ailments (are) important," he said, rather than having "too much pill pushing going on" as society has now.

"I believe that teaching people how not to get sick is much better then teaching people to pop pills and use medicine as a crutch," Dinwiddie added. "I feel as the health care industry must grow to more providers, so prices will drop because of more supply then demand."

We should "reward doctors for finding solutions, not for pushing pills," Dinwiddie said.

Rik Combs, of Lohman, doesn't support Medicaid expansion.

"Currently, there are almost a million Missourians on Medicaid and it makes up over $9.9 billion of the (state's) annual budget, or about 36.1 percent," Combs explained. "In addition, Medicaid costs rose about 13.1 percent from 2012-2016 alone. The addition of another 230,000 on the Medicaid rolls (under the proposed expansion) would certainly burden state coffers even more and, with budgets tight as it is, this could prove a budget killer."

The federal matching money also concerns him, Combs said.

"The federal government currently pays about 63.4 percent of Medicaid costs," he noted, "but with the federal debt over $21 trillion and rising each day, Missouri can't count on the federal government (our tax dollars) to continue assisting with the bills."

The federal law also made changes to how hospitals are reimbursed under the separate, federal-only Medicare program.

But some have complained that the changes have caused some hospitals — especially in rural areas — to close because Missouri lawmakers have not expanded Medicaid.

Leydens said she thinks the issues are separate.

"I don't think this had much to do with the hospital closings," she said.

Veit acknowledged the loss of some rural hospitals in Missouri.

But he said he's not ready to promote solutions to slow down or stop that loss without first sitting down "with the Missouri Hospital Association and the rural hospitals that are affected, and (weighing) the effect it's having on them."

Veit thinks a greater use of telemedicine, "using more physician assistants and nurse practitioners," and working to get a better hospitals reimbursement formula all are steps that all hospitals should be taking to improve their financial health.

Dinwiddie and Combs didn't comment on the hospitals situation.

Candidate Kendra Lane, of Jefferson City, did not respond to requests for comment for this story.

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