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Missouri Politicians Hopeful of Medicaid Expansion Compromise

Missouri policy makers might be inching toward middle ground that would expand Medicaid eligibility while reforming the safety-net program to encourage recipients to work, two key participants in the talks said Monday.

The comments came from Missouri Gov. Jay Nixon, a Democrat, and state Rep. Noel Torpey, an Independence Republican.

The two appeared at a community meeting in Kansas City, Mo., where U.S. Rep. Emanuel Cleaver, a Kansas City Democrat, joined them in touting the benefits of a Medicaid program that is open to more low-income Missourians. The meeting drew an audience of about 140 people.

“There is always room for compromise,” Torpey said, “so hopefully we can get something done.”Under the Affordable Care Act, the federal government has pledged to pay 100 percent of the costs of newly eligible Medicaid recipients in states that boost eligibility to 138 percent of the poverty level – $15,856 for individuals and $35,325 for a family of four. The offer of full reimbursement runs from 2014 through 2016, after which the federal share would gradually decline to 90 percent, where it would remain. 

The Missouri budget office estimates the net positive impact on general revenue would amount to more than $600 million between 2015 and 2018, when taking into account the increased federal reimbursement and savings achieved through better patient outcomes.

Nixon and other expansion proponents failed to sway the General Assembly last year, but the governor said the climate seems better this time around.

“I’m seeing much more movement than we were seeing at this same time last year on both sides, in the House and the Senate, and on both sides of the aisle,” Nixon said. “So compared to last year we have made a significant amount of progress.”

As of December, according to the Kaiser Family Foundation, Missouri had about 834,000 uninsured residents. Of those, about 193,000 adults would be covered if the state expanded Medicaid. In Kansas, according to the foundation, about 78,000 adults out of an overall uninsured population of roughly 369,000 would gain coverage through a Medicaid expansion.

In Kansas, the state hospital association has hired a consulting firm headed by former U.S. Secretary of Health and Human Services Mike Leavitt to aid its push for Medicaid expansion. The firm issued a report last month that recommended taking a more private-sector approach to expansion.

Unlike in Missouri, the report hasn’t seemed to generate any momentum behind the expansion issue. Gov. Sam Brownback, a conservative Republican and vocal opponent of the federal health reform law, said last week that he didn’t think Kansas should expand Medicaid eligibility when the state has thousands of people with physical and developmental disabilities on waiting lists for services.

During the summer, Torpey served on two special legislative committees that studied the issue of Medicaid expansion. He said he came away with the sense that most people don’t want to see the state Medicaid program expanded unless lawmakers reform it as well.

Torpey chaired the Interim Committee on Citizens and Legislators Working Group on Medicaid Eligibility and Reform, which gathered testimony around the state and forwarded its findings to the Interim Committee on Medicaid Transformation. Torpey was vice chairman of that committee.

He has introduced legislation that would increase Medicaid eligibility to individuals at 100 percent of the poverty level. The state would then use federal Medicaid dollars to help individuals making up to 138 of the poverty level purchase plans on the private-insurance marketplaces established by the health reform law.

At a state House committee hearing last week, some witnesses expressed doubt that the federal government would grant authority to implement the work participation requirements in the legislation. To be eligible for the state Medicaid program, Torpey’s bill says applicants would have to provide “proof of workforce participation.”

“I’m a big fan of that,” he said Monday. “I think when people get things for free they don’t truly appreciate it.”

Nixon agreed.

“Right now we have a system that rewards people for not working,” he said. “If you are sick and need health care, oftentimes the way to get that is to quit your job (to fall below the income threshold). That makes no sense at all, and having solid, realistic work requirements is something we can all come together on – absolutely.”

The forum took place at St. James United Methodist Church, the congregation that Cleaver once led and where his son now serves as senior pastor. 

“This is not a political issue,” Cleaver said. “It is a moral issue.”

Mike Sherry is a health reporter for the Hale Center for Journalism at KCPT.


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