State lawmakers failed to reach a compromise on health care this legislative session, as House Republicans rejected a proposed expansion of Medicaid.
The health care debate became one of the dramas that played out the last week of the legislative session, ultimately ending in defeat. It began with Governor Nixon, a Democrat, proposing at the beginning of the session to expand Medicaid to cover an additional 35,000 Missourians. When the Republican-controlled legislature balked at the cost during a very tight budget year, the governor turned to the hospitals. The Missouri Hospital Association agreed to voluntarily raise the provider tax hospitals pay to generate an additional $52 million for the state. Under the Nixon plan, that money would be used to draw down $92 million in federal funds to pay for the Medicaid expansion. The plan was sold as a way to expand Medicaid at no cost to the state.
Senate Republicans supported the idea. House Republicans rejected it.
House Republicans refused to consider raising the Medicaid eligibility level to 50% of the federal poverty level. Discussions with Senate Republicans during the last week of the legislative session proved fruitless. Rep. Kevin Wilson, a Republican from Neosho, says House Republicans wanted to use the high-risk insurance pool model and cover people who couldn’t get insurance due to pre-existing conditions.
"So ours (House Republicans) is based on a health need," Wilson explained to reporters during a post-session news conference. "Their plan (Senate Republicans) is based on an arbitrary income figure."
The conflict between the opposing plans nearly derailed budget talks, holding up approval of the social services budget, HB 11 , in the House. A conference between Senate and House budget writers failed to resolve the conflict until the two sides reached an agreement that the Medicaid expansion would be taken out of HB 11 in exchange for the House considering SB 306 , a health care expansion proposal sold as an alternative to Governor Nixon’s plan. The House couldn’t reach agreement with the Senate on an acceptable form of SB 306.
Still, Majority Floor Leader Steven Tilley of Perryville insisted House Republicans lived up to their agreement that ended the stalemate and led to approval of the $23 billion state budget. He said House leadership merely agreed to negotiate on SB 306 with the understanding that if either party was uncomfortable with the compromise language neither would bring the bill up for debate.
"There were discussions and we just couldn’t come to a compromise on it," Tilley said. Minority Floor Leader Paul LeVota (D-Independence), the top Democrat in the House, said he never understood why an agreement wasn’t reached.
"To me, it’s amazing, that the Senate Republicans would be so behind the idea and the House Republicans would roll them on the idea," LeVota said during a post-session news conference, "So we knew very clearly they had some strength there, so we wanted to do what we could to compromise to get someone covered, somewhere."
LeVota called the failure of expanding health care the biggest disappointment with the session.