April 18, 2014

Plan to save money on Medicaid expansion would mean reduced eligibility to children

Some state lawmakers are balking at the concept of saving the state money to expand Medicaid by eliminating coverage for some children.

Representative Jay Barnes (right) presents concepts for reform of Medicaid to the Interim Committee on Medicaid Transformation.

Representative Jay Barnes (right) presents concepts for reform of Medicaid to the Interim Committee on Medicaid Transformation.

Representative Jay Barnes (R-Jefferson City) has outlined his idea to the House Interim Committee on Medicaid Transformation, which he chairs, to increase Medicaid eligibility enough to draw federal dollars as Democrats have wanted to do. To do it, he proposes the elimination or reduction of coverage for some groups including some children in low- to middle-income families.

Barnes calls the State Children’s Health Insurance Program (S-CHIP), “more liberal than the Affordable Care Act,” and he says that is why the state can pare it back. It currently extends coverage to children in families with income that is up to three-times the federal poverty level.

Barnes notes that families making more than one-and-a-half times the federal poverty level pay a premium on S-CHIP coverage, and says it would cost less for those families to buy a federally subsidized health insurance program on an exchange.

Representative Sue Allen (R-Town and Country) says she would rather continue the coverage to families whose spending habits are based on having it.

“We take care of children now better than some able-bodied adults,” she says. “Children have no way control or ability to impact the way a parent or two parents utilize their family resources.”

Representative Keith Frederick (R-Rolla) expresses his concern that Barnes’ plan would free up money in the state budget at the expense of piling on to the nation’s debt.

Representatives Keith Frederick (left) and Jay Barnes.

Representatives Keith Frederick (left) and Jay Barnes.

“The savings to us is by virtue of offloading the expense to basically our future generations. That’s a philosophic difficulty for me. If we carry it out to its logical conclusion, then in every instance that a state or any entity can save money if they offload it to the exchanges, they save money in their own little world, but as a nation it sinks us.”

Representative Chris Kelly (D-Columbia) responded to Frederick, noting the origin of Medicaid, “We are unloading our cost from one aspect of a federal program to a different aspect of a federal program. Missouri didn’t invent our current Medicaid scheme. The feds did. Now the feds are saying, ‘You can do this differently and we’ll pick up more of the cost.”

Barnes defended the concept. He tells the committee, “I’m comfortable with saying the State of Missouri should not pay for health insurance for a family that makes 300-percent of the federal poverty level.”

Barnes says a bill could be ready by some time in January. His overall plan would also eliminate or reduce coverage in the areas of care for the blind and women’s health, and projects a savings by Fiscal Year 2021 of more than $42-million.

His committee will meet again November 19, and then with its Senate counterpart and the Governor November 26.