April 24, 2014

House sends $26.6-billion budget to Senate (VIDEO)

The state House has approved a $26.6-billion budget for the fiscal year that begins July 1. The House’s proposal now goes to the Senate.

Because legislative budget makers disagreed with Governor Jay Nixon (D) on an estimate of how much revenue Missouri will receive in the next fiscal year, House budget makers propose spending up to their projection, then propose appropriations out of a new surplus revenue fund any amounts higher.

The spending plan includes a $122-million increase for K-12 education out of general revenue, with another $156-million possible out of the surplus revenue fund.

House Budget Committee Chairman Rick Stream (R-Kirkwood) outlines some key items in the House’s proposed budget (courtesy; Jonathan Lorenz, Missouri House Communications):

During Thursday’s discussion in the chamber, House Democrats offered their strongest criticism of the two-tiered approach.

House Budget Committee Chairman Rick Stream (photo courtesy; Tim Bommel, Missouri House Communications)

House Budget Committee Chairman Rick Stream (photo courtesy; Tim Bommel, Missouri House Communications)

“Underestimating revenue means that the $156-million recommended by the Governor for the foundation formula will not be distributed to local school districts until everything else in the state budget is funded this year,” said Representative Margo McNeil (D-Florissant). “It means that money will not be available for this school you. You cannot budget for something you don’t know that you will receive. Underestimating means that Missouri school districts will plan less and will achieve less.”

McNeil was critical of the House budget having a 1-percent decrease in the number of state employees and the change from a 3-percent raise in state employee pay partway through the year recommended by the Governor to a 1-percent increase.

Representative Jay Barnes (R-Jefferson City) says the revenue projections used by House budget makers are more realistic.

“The Governor brought us a budget based on pixie dust predictions and long shot legislation.”

The proposal does not include federal money for the expansion of Medicaid. Republicans saying accepting that federal money would increase the national debt and continue to put money into an inefficient program. Democrats say expansion would extend health care to hundreds of thousands of Missourians and would free up more money in the budget for other needs such as education.

Hearings continue on proposed Medicaid reform, expansion plan

A House Committee will continue its hearings on a Republican proposal for reform and expansion of Medicaid Monday afternoon and Tuesday morning.

The Committee on Government Oversight and Accountability will hear Monday at 2 p.m. the portions of the legislation dealing with health care homes, managed care, and managed care requirements. In a hearing Tuesday beginning at 8 a.m. the committee will discuss the “Show-Me Healthy Babies program,” proposed to provide medical coverage to unborn children through the Children’s Health Insurance Program (CHIP), increases in eligibility, and coverage for high-cost Medicaid recipients with complex medical conditions who would fall under a new category of “medically frail.”

The hearings will take place in Hearing Room 3 in the basement of the State Capitol.

The proposal is HB 1901, sponsored by Representative Noel Torpey (R-Independence).

Earlier stories:

Hearing highlights work requirement, premium in House Republican Medicaid plan

House Republican files Medicaid expansion, reform proposal

Hearing highlights work requirement, premium in House Republican Medicaid plan

A House Committee has held the first hearing of a Republican proposal for reform and expansion of Medicaid.

Representative Noel Torpey (photo courtesy; Tim Bommel, Missouri House Communications)

Representative Noel Torpey (photo courtesy; Tim Bommel, Missouri House Communications)

The first of three planned hearings to pick apart the bill has focused on reform components. Drawing the most criticism on the day are the proposals of a requirement that Medicaid recipients have a job, be looking for one or be a student, and that participants pay a premium of 1-percent of their income.

Saint Louis University law professor Sidney Watson tells the committee those might not be legal, and says there is a question of whether the secretary of the U.S. Department of Health and Human Services has the authority to grant waivers to allow them to become policy.

“The Secretary has never approved a straight premium charge that results in ineligibility for nonpayment,” says Watson of the premium proposal, “because of concerns that people earning below or near the poverty line can in any given month have problems coming up with those payment charges.”

The bill is written so that if those waivers aren’t both granted, the legislation as a whole would fail. Joel Ferber with Legal Services of Eastern Missouri urges the committee to remove that contingency.

“It just seems like a very potentially not very productive endeavor. I think the key is to either modify these two provisions or to loosen up the waiver provision so if you get 99.9-percent of the waivers you want you can still go forward.”

Committee Chairman Jay Barnes (R-Jefferson City) says he isn’t convinced those provisions would not be approved for waivers, and says they are key to the bill.

“I think it’s only fair that we require an able-bodied person to actually work before they qualify for Medicaid,” Barnes says. “I think Missourians are willing to help those who are willing to help themselves.”

Barnes hopes to have the next hearing on the Monday after next week’s Spring Break, with a focus on more reform components.

The legislation is HB 1901

See our earlier story on the legislation.

House Republican files medicaid expansion, reform proposal

A Republican plan for expansion and reform of Medicaid has been filed.

Representatives Jay Barnes (left) and Noel Torpey (right) were announced as the chairs of 2 House Interim Committees on Medicaid last summer by House Speaker Tim Jones (center).  (photo courtesy; Tim Bommel, Missouri House Communications.

Representatives Jay Barnes (left) and Noel Torpey (right) were announced as the chairs of 2 House Interim Committees on Medicaid last summer by House Speaker Tim Jones (center). (photo courtesy; Tim Bommel, Missouri House Communications.

Representative Noel Torpey (R-Independence) has filed the bill after chairing one of two House interim committees on Medicaid last summer. Torpey’s proposal takes a different approach from past legislation in that it would require Medicaid recipients old enough to work to have jobs.

It would extend Medicaid coverage to adults with incomes below the federal poverty level and, Torpey says, it would help people making between the poverty level and 138 percent of the poverty level buy private insurance on the federal exchange.

“Why not help people who are trying to help themselves?” Torpey asks. “From a state’s perspective it’s fiscally responsible.”

Torpey says another key component of the bill is transparency for hospitals.

“We should know what non-life-threatening procedures cost … time after time after time, they don’t want to share that information and that’s unfortunate,” says Torpey. “I think that in itself will help some of the costs in healthcare.”

The lead co-sponsor on the bill is Representative Jay Barnes (R-Jefferson City), who chaired the other of those interim committees and has filed Medicaid reform legislation in the past.

He says another chief difference between those bills and this one is the requirement of at least one-percent of a recipient’s annual income to be paid in a premium for a coverage plan.

“We need recipients to take the responsibility to pay some of their own money for their health insurance,” says Barnes. “Because they make lower incomes that’s going to be a lower amount of money, but I think it’s important that they pay what they can into the system in order to get their own health insurance.”

Legislative staff are still preparing an estimate of the impact Torpey’s bill will have on state revenue, and he believes it will save the state money.
“I’m eager to see how positive it is,” Torpey tells Missourinet.

Torpey’s legislation is HB 1901.

State officials testify to House Committee about execution procedures (AUDIO)

The Director of the Department of Corrections has for the first time spoken publicly about the questions and controversy raised in recent months over the carrying out of executions.

Director of the Department of Corrections George Lombardi testifies to the House Committee on Government Oversight and Accountability.  (photo courtesy; Tim Bommel, Missouri House Communications)

Director of the Department of Corrections George Lombardi testifies to the House Committee on Government Oversight and Accountability. (photo courtesy; Tim Bommel, Missouri House Communications)

George Lombardi has told the House Committee on Government Oversight and Accountability it is a statutory requirement that his Department conduct executions, and it is working within the statutory framework in place to do so.

“Keeping in mind, please,” Lombardi asks of the Committee, “Statute mandates the Department of Corrections to carry out executions. It doesn’t say, ‘Try your best.’”

He says it is because of that mandate that the Department looked “all over the country” for a way to acquire a drug to use in lethal injections when it became clear it could no longer use propofol.

“We found that there was a compounding pharmacy that was willing to [provide the drugs], and that’s what moved us forward to change the protocol accordingly.”

Lombardi did not confirm or dispute the identity of the pharmacy, reported to be located in Oklahoma and only now seeking a license in Missouri. He did confirm that the drugs are paid for in cash, something that he says has been true since the administration of Governor John Ashcroft.

Lombardi says all those involved in the execution protocol who must be paid are paid in cash. He says that is because those participants have made clear that they would not be involved if they were paid any other way. He says it was part of maintaining anonymity for those participants.

Lombardi tells the Committee that to pay those individuals in any other way would be “the de-factor abolishment of the death penalty.”

Listen to the testimony of Corrections Department Director George Lombardi, 28:30

His testimony was challenged by Attorney Joe Luby with the Death Penalty Litigation Center, who says Lombardi is “abusing” the state statute that requires the identities of members of an execution team to be kept secret.

“The same statute defines ‘execution team’ very narrowly,” says Luby. He quotes, “The execution team those persons who administer lethal chemicals and those persons such as medical personnel who provide direct support for the administration of lethal chemicals.”

That shouldn’t include the pharmacy, says Luby, who says then that the pharmacy’s identity should not be kept secret and it should therefore not be paid in cash.

Luby also accuses Corrections of moving too quickly in carrying out executions.

“It is absolutely unacceptable for the state to execute prisoners before the courts can resolve their claims. That has been the case with the last three prisoners who were executed in this state. This is a uniquely Missourian pattern of behavior.”

A federal judge has also been critical of the timing o the execution of Allen Nicklasson in December.

Assistant Missouri Attorney General David Hansen tells the Committee Missouri has acted within the law.

“The law is clear that the pendency of litigation is an insufficient reason to stop an execution,” Hansen says. “On January 29th, the date of [Herbert] Smulls’ execution, the State of Missouri directly went to the United States Supreme Court and asked if the execution should happen. The Court said no, the execution should not be stopped. They said that three different times on that day.”

The Chairman of the Committee, Representative Jay Barnes (R-Jefferson City), says he is satisfied that Missouri has not executed while a stay was in place that should have halted it.

As for what action, if any, he thinks the legislature needs to take based on what it learned on Monday, Barnes says, “I don’t think there’s any chance of any moratorium being put in place. I also think … the legislature out to take a close look at the procedures, especially how pharmaceuticals are procured.”

Barnes refers to legislation offered by Representative John Rizzo (D-Kansas City), that proposes a moratorium while an 11-member panel reviews death penalty and execution protocol.  His legislation (HB 1409) has been assigned to the House Judiciary Committee but a hearing has not been scheduled.

“I really feel like this process is being spitballed together in an aspect to carry out the law,” says Rizzo, “but in the process maybe does violate law.”

Rizzo says the legislature needs to have some oversight into the execution process.

“The policy invariably forces illegalities,” Rizzo says he learned on Monday. “The Director (of corrections) has to carry out an execution, but there are no pharmaceuticals available to do that. Then he has to go above and beyond to actually go to a pharmacy that’s not regulated by the State of Missouri that, in essence, violates FDA regulations.”

Barnes noted legislation filed last week by Representative Eric Burlison (R-Springfield), HB 1737, that would make the execution protocol subject to review by the Joint Committee on Administrative Rules as being one avenue for increasing oversight.  That bill has not been referred to a committee.  Rizzo is one of its co-signers.

Missouri is scheduled to carry out another execution on February 26; that of Michael Taylor, who pled guilty in the abduction and murder of 15-year-old Ann Harrison girl in Kansas City 1989.