The expansion of Medicaid in Missouri is a huge and complicated proposition. Gov. Nixon has only visited our majority caucus meeting once since I have been in office, and the subject of his visit was Medicaid expansion.
Traditionally, the Medicaid program has primarily been a program for the poor. The expansion extends eligibility to people with income up to 138 percent of the federal poverty level.
The carrot on the stick is that the federal government will fund the expansion at 100 percent for the beginning years and 90 percent federal and 10 percent state funding for subsequent years. This sounds good at first, but there are some inherent problems.
Missouri has been able to maintain its Triple A Bond rating thus far by careful management of its revenue. The most challenging aspects of any budget are dealing with those expenses that cannot be controlled. Medicaid, because of its entitlement status, is one of those expenses.
Medicaid is a budget item that has experienced growth without changes in the program. The federal/state match for Medicaid is approximately 60 percent federal and 40 percent state. The only control we have on the growth of the program costs is to modify the eligibility requirements or perhaps reimbursement rates. Furthermore, it is calculated that only 66 percent of eligible recipients actually receive assistance. There is a huge concern that expanding the program could result in the “woodwork effect” of bringing more people into the program where the reimbursement rate is 60/40.
Another problem is the lack of providers. Many medical providers simply do not accept Medicaid or limit their practice to a low percentage of Medicaid patients. It is feared that expanding the program may result in some providers dropping their acceptance of Medicaid altogether.
We have no guarantee that the expansion of the program will continue at the 90/10 rate. I previously worked as a caseworker determining eligibility for Medicaid clients for almost 20 years. I have never thought of Medicaid in terms of providing an “economic boon” to our economy. I have always thought of it as being an expense for a safety net for the poor and people who have fallen into unfortunate circumstances. I still believe that this expansion is not a “free lunch” because someone must pay for it. The taxpayers ultimately carry the load.
I do believe that consideration of Medicaid expansion does represent an historic opportunity to transform the program. The House Bill under consideration is the beginning of the discussion of what could be a unique “Missouri Solution.” The provisions of the bill involves the private sector and gives the consumers choice in selecting coverage. It also requires waivers from the federal government to implement.
I am pleased that Speaker Jones accepted my nomination of (Nurse Practitioner) Kathy Haycraft to be on the Interim Committee on Medicaid Transformation. It began with Kathy’s interest in being on the committee and her desire to serve. I have the utmost confidence in her knowledge and experience as an Advanced Practice Registered Nurse. She regularly keeps me informed on the progress of the committee. It is my hope that the proper balance of responsibility providing for healthcare coverage between the individual, family, government, and employer will be maintained in any forthcoming legislation.