November 28, 2014

Subject of expansion divides Senate panel on Medicaid reform

The work of the Senate Interim Committee on Medicaid Reform and Expansion has ended with its minority members breaking away to write their own report on its findings. This comes after the Republican majority led a vote to reject recommendations regarding eligibility expansion over Democrat objections.

The Committee discussed a draft report with 16 bullet point recommendations. Senator Jamilah Nasheed (D-St. Louis) asked Committee Chairman Gary Romine (R-Farmington) why expansion was not among them.

He told her, “Because it was not under the purview or the auspices of this committee’s responsibility.”

Romine elaborated, telling Nasheed the committee was charged with looking for ways to make Medicaid more efficient before expansion can advance. “If we get this accomplished, then any other legislation that’s presented will have a better fighting chance … but until we reform and transform the current Medicaid program, no one’s in a position that they feel confident expanding anything to any additional eligibility.”

Democrats objected, noting that a great deal of testimony taken by the Committee dealt with expansion. Romine notes that testimony is included in the report, but Nasheed and her fellow Democrats were not satisfied. They pushed for the Committee to discuss expansion issues first, and when it did not, they walked out.

“I’ll come back when we’re ready to deal with Medicaid expansion,” she told Romine, and walked out joined by Senators Paul LeVota (D-Kansas City) and Joseph Keaveny (D-St. Louis).

The three returned with their own recommendations and asked the committee to vote to include them. Those included stating that “the majority of testimony” to the committee said that the state should expand Medicaid and accept federal money for doing so, that the General Assembly should consider waiver options for expansion, acknowledging Office of Budget and Planning estimates that the state would realize General Revenue savings under expansion and the findings of a Kaiser Commission report that says states not expanding Medicaid expect a larger increase in their state budget portions going to Medicaid compared to those moving forward with expansion.

Those recommendations were rejected.

Senator Rob Schaaf (R-St. Joseph) then recommended the committee include tort reform in the report.

“One of the big drivers of healthcare is defensive medicine,” Schaaf said. “It’s been estimated that as much as twenty percent of the cost of healthcare is as a result of lawsuits, so I would ask that tort reform be included in the report to lower the cost of healthcare overall.”

Schaaf’s proposal earned derision from LeVota.

“Based on our charge and based on the fact that we just rejected the biggest cost-saving thing is ridiculous,” LeVota said. “The integrity of this committee, which I think is already gone because we’re not dealing with the number one thing, but adding this in there would be … talk about a waste of time.”

The Democrats on the Committee said they would write their own minority report that will include recommendations regarding eligibility expansion.

Asked whether he thought the impasse in the committee was a sign of things to come if Medicaid expansion reaches the Senate floor in the 2014 session, LeVota expressed optimism.

“I’m going to continue to have hope that the common sense of this will be overwhelming and we’ll be on the path to do what other states did and look at this opportunity, and create it our own way.”

Recommendations the committee did put in its report to transform Medicaid include putting low-income parents, children and pregnant women on Medicaid into private managed care plans. It estimates managed care could save the state between $14 million and $15 million dollars annually.

It also recommends raising the asset limit for the elderly and disabled from $999 for a single person and $2000 for a couple to $2000 for a single person and $3000 for a couple, adding dental care for adults and encouraging health savings accounts to be used for deductibles and copays.

The Senate Committee will join its House counterpart on November 26 in a joint session with Governor Jay Nixon.