The Missouri legislature's fight on whether expand Medicaid

by Mary Ann McGivern

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Missouri's Democratic governor, Jay Nixon, supports Medicaid expansion, but the veto-proof Republican legislature opposes it. I sat in on one of the hearings. Objections included that the government is broke and cannot meet the obligations of Medicaid expansion; that Medicaid is broken and cannot serve the sick poor; that government should not take on the obligation of care of the sick; that the program is filled with fraud and waste. In short, they don't like Medicaid expansion.

Current Missouri rules declare people eligible for Medicaid assistance if they earn less than 42 percent of the federal poverty level. That's $4,584 a year for a mother with two children. Medicaid expansion would cover people earning up to 138 percent of that federal poverty level, or $19,530 for that mom with two kids. (Or maybe it's $26,000. My sources, the Missouri Catholic Conference and the Missouri Association for Social Welfare, disagree.) Whatever. Everyone agrees Medicaid expansion would add 260,000 working people to Missouri Medicaid rolls and add 24,000 jobs.

Enter a "young Catholic attorney ... proposing a different kind of Medicaid bill that reforms the program." So says the Missouri Catholic Conference in its April 2 newsletter. The bill, HB 700, includes a partial increase in Medicaid eligibility but is written in direct conflict with federal law. It bans funding of abortion except to save the life of the mother; it cuts coverage for many children covered today; and it cuts coverage of some cancer treatment, resulting in fewer people actually covered. Analysts say if the bill becomes law, it will bring in no federal funds and increase state costs.

One of the collateral consequences will be cuts in services and closing of many small hospitals in rural Missouri. Currently, they receive federal reimbursement for the care of uninsured patients. But congressional funding for that reimbursement is scheduled to end with the implementation of Medicaid expansion.

The legislative term ends in early May. I'll keep you informed.

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