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Missouri’s state treasurer is warning against Medicaid expansion; both sides cite different numbers

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Missouri’s state treasurer and the House Budget Committee chairman will travel across the state on Monday, urging Missourians to vote against Medicaid expansion on the August ballot.

Missouri State Treasurer Scott Fitzpatrick speaks at a CARES Act funding working group on May 21, 2020 in Jefferson City (file photo courtesy of Tim Bommel at House Communications)

Medicaid, which is formally known as MO HealthNet, is a federal and state program that assists with medical costs for residents with limited incomes.

House Budget Committee Chairman Cody Smith, R-Carthage, tells Missourinet that Medicaid’s current budget is almost $12 billion for fiscal year 2021. The state’s current operating budget is about $35.2 billion.

Smith and State Treasurer Scott Fitzpatrick (R) will visit Joplin, Springfield, Kansas City, Creve Coeur, Cape Girardeau and Jefferson City on Monday. They’ll brief Capitol reporters immediately following the governor’s 3 pm press conference at the Statehouse.

Missourians will cast ballots on Amendment Two, the Medicaid expansion proposal, on August 4. If approved by voters, Medicaid would be expanded for residents between the ages of 19 and 64 with an income level at or below 133 percent of the federal poverty level, as set forth in the Affordable Care Act.

Medicaid expansion supporters say the measure would provide healthcare to Missourians who earn less than $18,000 annually.

Chairman Smith says the August Medicaid expansion ballot measure is projected to cost $200 million in state general revenue, and $1.8 billion in federal funding each year. He also says it will raise Missouri’s Medicaid rolls from 950,000 to more than 1.2 million participants.

Smith also says COVID-19 has had a major impact on Missouri’s economy.

“More than $1 billion has been cut from the state’s general revenue budget in recent months,” Smith says, in a statement. “Just this month, services requiring state support have been drastically reduced, including elementary school funding, college scholarships, and support services for those in need. Amendment Two will be a knockout blow to the state budget as more services will be cut or eliminated to pay for the healthcare of able-bodied adults.”

Supporters of Medicaid expansion disagree, saying the measure will create thousands of new jobs, many of them in rural communities.

The Missouri Chamber of Commerce and Industry and many unions have endorsed Amendment Two. The Chamber has quoted a study from the Missouri Foundation for Health, which says Medicaid expansion will create more than 16,000 new jobs annually during its first five years, while increasing personal income by $1.1 billion annually.

The Foundation for Health says most of the new positions would be outside of St. Louis and Kansas City, and that 90 percent of those jobs will pay more than $15 an hour.

Medicaid expansion supporters also say that Amendment Two will help keep rural hospitals open.

The Missouri Hospital Association (MHA) says ten rural Missouri hospitals have closed since 2014. Five of the ten ten closings happened in the southeast Missouri district of U.S. Rep. Jason Smith, R-Salem.

The Missouri Farm Bureau, the state’s largest general farm organization, is opposed to Amendment Two. Farm Bureau President Blake Hurst says it could cripple the state budget by imposing massive new healthcare costs on Missouri taxpayers.

37 states have expanded Medicaid.

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Sen. Blunt pushes for more information on federal health care application processing centers

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Missouri’s junior senator says he’s still waiting for answers, even after getting a reply to his inquiry about the workload at centers processing federal healthcare plan applications. Whistleblowers say there are too many employees and not enough work at centers managed by Serco in Wentzville and elsewhere in the country that are supposed to process paper applications to the federal health care system.

Senator Roy Blunt (R) and other lawmakers including Congressman Blaine Luetkemeyer (R) sent letters to the Centers for Medicare and Medicaid Services asking about the claims. Blunt says after a long delay he finally got a letter in response, that he says was “vague,” and he wants something better.

“I got a non-answer answer,” says Blunt of the letter he received from Marilyn Tavenner, Administrator with the Centers for Medicare and Medicaid Services.

“Did you really tell them to refresh their computer every ten minutes so it would look like they’re doing something,” Blunt asks of the working conditions at the Serco facilities. “Did you really bring library books and board games to work so that the people that taxpayers were paying would have something to do? Those are pretty simple ‘yes or no’ questions and I’d like some ‘yeses’ or ‘nos’ to those questions.”

The 1.25-billion dollar federal contract includes more than 3,000 employees. A reported 600 of those are at Wentzville.

MO House Speaker says VA problems support argument against Medicaid expansion (AUDIO)

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The Republican Speaker of the Missouri House says recent problems with the Veterans Health Administration support the stance his caucus has taken against Medicaid expansion. Tim Jones (R-Eureka) has been opposed to using federal dollars to expand eligibility for that program in Missouri since Governor Jay Nixon (D) raised the issue in late 2012.

House Speaker Tim Jones (photo courtesy; Tim Bommel, Missouri House Communications)

House Speaker Tim Jones (photo courtesy; Tim Bommel, Missouri House Communications)

He says issues that have come to light  – veterans needing care being on secret waiting lists, some veterans dying while waiting for care, and records being falsified to reflect shorter wait times than actually experienced – illustrate the problems of having government-run a healthcare system.

“We actually look extremely smart and wise in not expanding Medicaid up to this point,” says Jones.

“The VA healthcare system, the federal Obamacare law and state Medicaid systems – the commonality is they’re all run by a form of the government,” says Jones. “The Medicaid system has now got the heavy hand of the federal government trying to use the carrot-and-stick approach of using the federal bill to expand the state systems.”

“We cannot put our heads in the sand and ignore potential similarities and analogies that can be drawn between the federal government running one massive national healthcare system on one hand versus another,” he adds.

Jones says Medicaid must be reformed rather than just have millions more in tax dollars be applied to the current system.

Medicaid expansion is an issue many Democrats running this year for state legislative seats will focus on.

AUDIO:  Jones says running on Medicaid expansion in this year’s campaigns would be a mistake

Hospital Association VP says defunding healthcare reform could hurt its members

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The Missouri Hospital Association says if the federal healthcare reform law is defunded, it will have a drastic impact on hospitals in the state and nationwide.

The House has passed a resolution that would fund the government through December but would pull funding from the president’s healthcare reform plan.

Missouri Hospital Association Vice President Dave Dillon says he understands what Republicans in the House want to do, but says they must remember that the program will cut money to hospitals to pay for the uninsured in anticipation that the money they propose pulling would result in more people with insurance.

“All of those payment cuts are going into place no matter whether the federal government defunds the increases in the insured population. So, what we would see would be over the course of ten years $4-billion in cuts without any corresponding increase in the people who can pay for care.”

Dillon says if Republicans really want to stop the plan alternately called “The Affordable Care Act,” or “Obamacare,” it will require some tough sells.

“It would be very difficult to pass a law that would rescind the ability of individuals to stay on their parents plans until they’re 26 years old. It would be very difficult and unpopular to rescind the extension of insurance without regard to preexisting conditions and without lifetime limits. Those things would be absolutely make or break for the insurance industry.”

Senator Claire McCaskill says the Senate will vote to restore funding to federal healthcare reform and send the resolution back to the House. The situation must be resolved by Monday, the first day of the federal fiscal year, or a shutdown to federal programs and services could result.

House Speaker opposes expansion of Medicaid eligibility in Missouri

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The Republican Speaker of the state House says future Missouri taxpayers will not be able to afford the expansion of Medicaid.

House Speaker Tim Jones (R-Eureka) Photo courtesy, Tim Bommel, Missouri House Communications.

Governor Nixon says he will include Medicaid expansion in his proposed budget for fiscal year 2014. It would extend Medicaid coverage to those making up to 138 percent of the Federal Poverty Level, or an estimated 300,000 Missourians that are currently uninsured. The expansion would be paid for by federal funds through the end of calendar year 2016.

Speaker Tim Jones says that’s not free money.

“At some point it comes from Missouri taxpayers, and something is going to either have to be cut or taxes are going to have to be dramatically raised to continue to support the president’s health care plan.”

After 2016, the state would take over paying for part of the Medicaid expansion. The state would pay five percent in 2017, six percent in 2018, seven percent in 2019 and 10 percent in 2020.

Jones says that plan can’t be counted on due to the national debt.

“I just spoke with some experts in the health care industry and they told me that 90 percent match could just be, if you read the regulations the right way, it could just be a maximum, which means the federal government could start dialing that back and asking the states to even shoulder more cost.”

Jones cites a study by the Kaiser Foundation, which he says supports Medicaid expansion, that says the expansion would cost Missouri $1.6 billion between 2013 and 2022.

“The Missouri budget is 23 to 24 billion dollars. When you start talking about costs in the billions … I have to ask Governor Nixon, I didn’t notice in any of his fly around press statements today that he described how we were going to pay for this cost.”

Jones also criticizes the governor for not announcing his intention to support Medicaid expansion until after the election. Jones thinks doing it earlier could have hurt Nixon in his reelection bid.

“I don’t know if he would have lost or not … he did win by a comfortable margin. However, this is a hot-button issue and this could have been one of those issues that … if the Governor had come out early enough and said firmly, ‘I am going to be in favor of full Medicaid expansion … full welfare expansion,’ that may have turned the tide of the election and he may not have won reelection.”

Jones notes each time Missourians have been given a chance to vote on something related to the Affordable Care Act, they have rejected it. He also says there are other ways to deal with health care issues.

“That could be done through free market reform, through transformation of Medicaid. We can make the health care system more accessible but there’s going to have to be some reform in the system as well and I’d rather the states completely handle it on their own.”

Jones says the priority should be getting Missourians back to work, though Nixon says the expansion of Medicaid would create 24,000 new jobs in Missouri in 2014 alone.

Missouri GOP delegation likes what it hears from Paul Ryan (VIDEO)

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Republican Vice Presidential Candidate Paul Ryan has formally accepted his party’s nomination, at its National Convention in Tampa, Fla. He spoke about the economy, health care and set the stage for Presidential Candidate Mitt Romney to speak tonight.

Missouri’s Congressional Delegation responds to comments from Vice Presidential Candidate Paul Ryan at the 2012 Republican National Convention.

The speech energized convention attendees, including Missouri’s delegation, and there are ties to Missouri to be found in his comments.

Ryan focused much of the speech on the Affordable Care Act. Conservative Missourians turned out in big numbers in 2010 to vote for Proposition C, meant to disarm the Affordable Care Act in the state.

Lafayette County Republican Kay Hoflander says that could be the key issue in this campaign for conservative Missourians.

“He spent a lot of time on Obamacare, and that was really clear,” she says. “I thought his message was straightforward, very easy to understand, very clear … Obamacare is what is destroying Medicare, not the Paul Ryan Plan.”

Hoflander says Medicare is an issue of particular importance to her.

“I’m 65 and I’m on Medicare myself,” Hoflander says. “If people could understand what he said, which was, ‘we’re not going to bleed it to death like Obama and the Democrats want to do.’ They just want to bleed it to death. They have no plan to save it for my children, my grandchildren, but (Ryan) does.”

Hoflander says the speech sent the right messages.

“Exactly what Republicans would like to say to independents, or to Democrats, or to people that are undecided or people that misunderstand what his Medicare program is all about,” she says. “He answered it all tonight.”

Some ad campaigns and messages circulating on the internet try to tie Ryan to Missouri Congressman and U.S. Senate candidate Todd Akin, who is under fire including from fellow Republicans for comments made last week about abortion in cases of rape.

See our earlier stories on Todd Akin

Hoflander says it’s not clear how the Akin controversy might play out. “The national polls are not good for (Akin). I think he has some internal polls that he’s saying are good, but the national polls don’t look good. There’s some time, though, so it’s possible, but we just have to wait and see. I know that Democrats have tried to tie Romney, Akin and Ryan all together, but I don’t think that’s going anywhere … I don’t think it’s sticking.”

Romney will address the RNC tonight and formally accept the party’s nomination for President.

 

Republicans to file court challenge to health exchange ballot language

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Lieutenant Governor Peter Kinder doesn’t like Secretary of State Robin Carnahan’s ballot language for an issue related to the federal health care law, and he says he’s going to fight it in court.

Lieutenant Governor Peter Kinder and Secretary of State Robin Carnahan

The issue would bar the Governor from creating a health insurance exchange as related to the Affordable Care Act unless lawmakers or voters give him that authority. Kinder says the summary Carnahan has released to describe that issue on the November ballot is misleading.

It reads: “Shall Missouri law be amended to deny individuals, families, and small businesses the ability to access affordable health care plans through a state-based health benefit exchange unless authorized by statute, initiative or referendum or through an exchange operated by the federal government as required by the federal health care act?

“No direct costs or savings for state and local governmental entities are expected from this proposal. Indirect costs or savings related to enforcement actions, missed federal funding, avoided implementation costs, and other issues are unknown.”

Kinder says, “To use the very active verb ‘deny’ individuals, families and small businesses the ability to access affordable healthcare plans is outrageously biased. On its face it’s biased. I have not talked to anyone who believes it’s fair.” He says the language is worded “as though the Obama White House had written the language to illicit from Missouri voters a negative result.”

Kinder says he’ll file a lawsuit challenging the wording, “if not Friday then early next week at the latest.” He adds that House Speaker Steven Tilley (R-Perryville) and Senate Majority Floor Leader Tom Dempsey (R-St. Charles) have already committed to joining that suit.

Kinder says he won’t use public money for the suit, adding he doesn’t anticipate any problems getting private dollars to back it.

Carnahan’s office, in a statement, says “This office has always followed our legal obligation to provide Missourians with fair and sufficient summaries of ballot initiatives, and this summary is no different.”

Secretary of State Spokesman Ryan Hobart adds, “we feel it confident it will hold up in court,” and points out the state legislature had an opportunity to write its own ballot language and did not.

House proposal would bar enactment of the Affordable Care Act (AUDIO)

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The House has given first round approval to a proposal that would bar enforcement of the federal Affordable Care Act, and makes it a crime to try to enact any portion of it in Missouri. House Democrats found a number of reasons to oppose the bill.

Representative Kurt Bahr (picture courtesy, Missouri House Communications)

Its sponsor, Representative Kurt Bahr (R-St. Charles) said while introducing the legislation that the federal healthcare law is unconstutitional. “It is our duty as state legislators, as the sovereign State of Missouri to uphold our end of the Constitution … of this interstate compact of the Constitution, and when the federal government oversteps its bounds it’s our duty, our obligation, to stand up and say, ‘That is not what the Constitution allows the federal government to do. We will not allow you to implement that piece of legislation on our citizens.'”

Representative Genise Montecillo (D-St. Louis) asks Bahr if the U.S. Supreme Court issued a ruling on the constitutionality of the Act, and she somehow missed it. “My understanding is that is still open to interpretation. We probably disagree on the constitutionality of that but you kind of assert that with some authority.

Bahr concedes, “We are still waiting on the Supreme Court to make their final decision on the constitutionality of the Accordable Care Act.”

Representative Margo McNeil (D-Florissant) says the state should allow the ACA to stand, for all the ways it will benefit Missourians. When Bahr restates his assessment that the Act is unconstitutional, she questions how he comes to that conclusion. “According to the representative from the 19th District (Bahr)?”

Bahr answers succinctly, “Yes.”

See the proposal, HB 1534

House Democrats also say Missouri has no power to resist the Act if it becomes law. Representative Chris Kelly (D-Columbia) says the bill oversteps the legislature’s authority. “Just because you don’t like the federal law, and it’s somebody else’s job to find whether it’s constitutional or not, does not give us the power to leap way, way out of our obligations. This is the antithesis of limited government.”

Kelly summed up his feelings about Bahr’s proposal, “This is breathtaking in its contempt for the Constitution of the United States.”

The bill was perfected 109-41 on a roll call vote. Another positive vote would send it to the Senate.

AUDIO:  Representative Genise Montecillo inquires Representative Kurt Bahr, 2:56

AUDIO:  Representative Margo McNeil inquires Representative Kurt Bahr, 9:24