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Missouri lawmakers to tackle Medicaid expansion issue on Tuesday

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A Missouri House subcommittee will hear testimony on the issue of Medicaid expansion Tuesday at the Statehouse in Jefferson City.

State Rep. Steve Helms, R-Springfield

The House Subcommittee on Health Care Reform will hold Tuesday’s hearing at 12:30.

Subcommittee chairman Steve Helms, R-Springfield, tells Missourinet his committee aim is to improve access to health care and make it more affordable for Missourians. Helms says the subcommittee is looking at ways to reduce costs for individuals.

Helms also tells Missourinet the subcommittee will issue a report to the full committee.

Medicaid expansion has primarily been a party-line issue in the Legislature, and Republicans currently control the House 113-43.

House Speaker Elijah Haahr, R-Springfield, opposes Medicaid expansion, saying it would take dollars out of the classroom. He notes it would require a ten percent match for the 90 percent draw down.

Speaker Haahr says Medicaid expansion “would blow a sizable hole in our general revenue budget,” because of the match.

Missouri House Minority Leader Crystal Quade, D-Springfield, briefs Capitol reporters on September 11, 2019, along with Assistant Minority Leader Tommie Pierson, D-St. Louis, and Minority Whip Keri Ingle, D-Lee’s Summit (photo courtesy of Tim Bommel at House Communications)

House Budget Committee Chairman Cody Smith, R-Carthage, shares Speaker Haahr’s position, because of the impact on the state budget.

House Democratic Leader Crystal Quade, D-Springfield, supports Medicaid expansion, saying 100,000 children have lost their Medicaid health care coverage. She says it’s an emergency.

Statistics provided by the state Department of Social Services (DSS) show the number of Missourians on Medicaid has decreased from 953,000 in August 2018 to 850,000 now.

State Rep. Deb Lavender, D-Kirkwood, predicts state revenue will increase, if Medicaid expansion happens. Lavender is the ranking Democrat on the House Subcommittee on Appropriations for Health, Mental Health and Social Services.

Lavender notes eight rural Missouri hospitals have closed in recent years.

Missouri’s Medicaid budget is now about one-third of the state’s approximately $29 billion operating budget.

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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

Two House Republicans’ letter seeks to sway Nixon on transfer legislation

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Two Republicans who have crossed party lines to work on Medicaid expansion say Governor Jay Nixon (D) needs to heed his own advice and work across lines to not veto the proposed transfer bill.  They have written a letter to Nixon on the issue.

Representative Jay Barnes (R-Jefferson City) and Representative Noel Torpey (R-Independence) say Nixon has in more than one State of the State Address called for working across political, geographical and other lines to solve problems. Barnes says that’s what they’re asking him to do with the transfer bill.

“That’s exactly what happened with Senate Bill 493,” says Barnes. “You saw a bill that the Senate passed 29-3, the House passed it with a bipartisan majority of 89 votes – obviously a little bit closer – but this is a bill which required a lot of work, a lot of compromises all around.”

See Barnes’ and Torpey’s letter to Gov. Nixon

Torpey says the bill isn’t perfect, but he wants to work with Nixon in the interim and next session to address the problems the governor has with the bill rather than see it vetoed.

“Education is such a complicated issue like Medicaid. I think it’s important to work together and to go forward,” says Torpey, “but to simply just blow a bill up, I don’t think that’s the right approach.”

Nixon says he can’t support a bill that would allow tax dollars to go to private schools. Barnes says that would make him like “legislative absolutists,” who make progress on key issues impossible.

The pair write, “Instead of insisting on a bill which is “perfect” to you, we ask that you read the bill as a whole. If you do, we believe you will find that the private option is only a small portion of the bill – a portion we believe is vital and necessary, but a small one nonetheless.”

Barnes says Medicaid and the transfer bill are similar in that both will require compromise, but he and Torpey both say their letter is not to suggest that they won’t work with Nixon on Medicaid if he doesn’t do what they want on the student transfer bill.

Maj. Floor leader: Dems unlikely to get the Medicaid expansion vote they want

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The Majority Floor Leader in the House says the chamber’s Democrats have already had what they say they want, before they will vote for a transportation sales tax increase.

House Majority Floor Leader John Diehl (Photo courtesy; Tim Bommell, Missouri House Communications)

House Majority Floor Leader John Diehl (Photo courtesy; Tim Bommel, Missouri House Communications)

House Minority Leader Jake Hummel (D-St. Louis) told Missourinet that his caucus wants a vote on Medicaid expansion before any of its members would vote on the proposed three-quarters-of-one-cent sales tax increase to support transportation.

Democrat support is expected to be needed in order for the transportation tax proposal to pass.

See earlier story

Representative John Diehl (R-Town and Country) says they’ve already had one, during debate on the budget.

“We allowed the Democrats to offer a Medicaid expansion amendment,” says Diehl. That amendment was offered during debate of the Department of Social Services budget. It was defeated 50-98.

Diehl did not say whether that legislation would be brought to a vote in this final week of the session. The Senate changed the bill to the three-quarters-of-one-cent proposal from the one-cent proposal that the House previously passed. The House has not officially acknowledged the Senate vote.

Of the possibility of the House holding a vote on Medicaid expansion to meet Democrats’ demands, Diehl says he, “can’t see that happening.”

House Democrats want Medicaid expansion vote before they’ll vote for transportation sales tax hike

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The Missouri House Democrats’ leader says they’re angry about the veto override on a tax cut bill, so much so that they won’t vote for a proposed sales tax hike to support transportation if the Republican House Majority doesn’t bring Medicaid expansion up for a vote.

The situation raises doubt about the fate of the three-quarters-of-a-cent transportation tax that had seemed likely to pass.

The House on Tuesday completed a legislative override of Governor Jay Nixon’s (D) veto of the tax cut legislation, SB 509, that he and House Democrats said was unnecessary and “dangerous,” and puts funding for state programs and services like education in jeopardy. All 108 Republicans in the House voted for the override along with one Democrat, Keith English (Florissant).

“I think right now the caucus feels that it’s awfully hypocritical to be asking for a tax increase when we’ve just cut taxes,” says Minority Floor Leader Jake Hummel (D-St. Louis).

34 House Democrats voted for the transportation tax, HJR 68, when it cleared the House, while 38 Republicans voted against it.

“They have to have our votes to pass it,” says Hummel. “If they’d like to give us a vote on Medicaid maybe we can talk about that.”

Hummel says it is time for Medicaid expansion to be brought to a vote on the House Floor. Last year a bill was debated in the House but withdrawn without a vote.

“If the majority [Republicans want] to vote it down that’s fine, but give us the opportunity,” says Hummel. “This is such a huge coalition across the state. Just give us … give everybody … a chance. Give them a vote. What are [Republicans] worried about? That they don’t have enough people to vote it down?”

House Speaker Tim Jones (R-Eureka) says he had not heard of the Democrats drawing the connection between the transportation sales tax and Medicaid prior to speaking to Missourinet.

“I don’t really see the connectivity between the two,” says Jones, “My gut reaction would be the caucus would not be much interested in a deal of that sort.”

If Republican leadership decides to put Medicaid expansion to a vote, there are some bills that could be potential vehicles for it. Two Senate bills, SB 504 and SB 754, are on the list of Senate Bills ready to be passed out of the House that relate to health care or insurance coverage. Those could potentially have Medicaid language amended to them before a vote.

Another bill, SB 524, was amended in a House Committee to include Medicaid expansion language in an effort led by Representative Chris Molendorp (R-Belton), who has been supportive of expansion. His position has put him at odds with most of his fellow Republicans. Molendorp called the vote, “symbolic,” but the bill could be brought to the floor in the final week.

“It’s that time of year when there are a lot of issues that aren’t related at all that kind of get thrown into the same pot for people to start picking and choosing … they’ll support this if you’ll support that,” says Senator Mike Kehoe (R-Jefferson City), the sponsor of the transportation sales tax bill in the Senate. “It doesn’t surprise me that there are people trying to tie one thing to another.”

Kehoe says he will spend time this weekend talking to legislators about moving the transportation tax forward.  It also has labor support, including from the Laborers Union of Missouri and the United Transportation Union, who testified for it during a House hearing in February.

Hummel says he knows there is union support for the tax, and a need for funding for infrastructure improvements.

“I don’t think a lot of us are happy at what the funding mechanism is for this,” says Hummel. “I’d love to get some kind of compromise between the tax and Medicaid, but just have to see how it goes.”

The proposal was to raise the sales tax one percent for transportation when it left the House but the Senate changed it to the three-quarters-of-a-cent plan.  If it is passed by the legislature it would go to voters in November or at a special election to be called by the governor.

Medicaid expansion supporters optimistic despite recent rejections

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Supporters of Medicaid Expansion aren’t giving up, even as the majority Republican party continues to assert its position against expanded eligibility.

Michelle Trupiano points to more than 2000 witness forms in support of Medicaid expansion submitted at a Tuesday morning hearing on a House Republican Medicaid bill as evidence of Missourians' support for Medicaid expansion.

Michelle Trupiano points to more than 2000 witness forms in support of Medicaid expansion submitted at a Tuesday morning hearing on a House Republican Medicaid bill as evidence of Missourians’ support for Medicaid expansion. 

The House on Tuesday twice rejected amendments to its proposed budget for Fiscal Year 2015 that would have included federal money for expansion. The day before, five Senate Republicans said they would block any attempt at expansion that would reach floor debate in their chamber.

Proponents say Missouri should accept expansion under the provisions of federal healthcare reform and the money from the federal government that would come with it.

Still, the Director of the Missouri Medicaid Coalition Michelle Trupiano says she remains optimistic.

“I’m feeling positive that with all the support from Missourians across the state saying, ‘Let’s figure out a way to do this,'” Trupiano tells Missourinet. “Whether it’s in Joplin or whether it’s in southeast Missouri or whether it’s in northwest Missouri, everybody’s saying we have to get this done this year … that we can’t afford another $2-billion passing us by.”

Among the various legislation that has been filed, Trupiano doesn’t know what the path to expansion is at this point.

“I think that there are several different possibilities, so we’re going to keep working on both the House and the Senate and find opportunities where they are to try to move expansion.”

Legislative Majority Republicans say the federal government doesn’t have enough money to support Medicaid expansion and say for Missouri to accept expansion would only add to the national debt, while applying more money to a broken system. Some Republican leaders say they prefer Medicaid reform over expansion of eligibility.

A House Republican proposal to expand and reform Medicaid is still moving in committee.

Trupiano says she thinks the expansion debate has advanced a lot since last year.

“Last year if you mentioned the words ‘Medicaid expansion,’ everyone just turned up their nose and said, ‘no,'” says Trupiano. “I think people are very open to it on both sides … to come to the table, to look at that compromise, to look at reforms that include also increasing the eligibility limits.”

She says she still believes Medicaid expansion can pass this year.

“Eight weeks are still a long time until session ends and a lot can happen during that time.”

House gives initial approval to proposed FY15 budget

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The state House has given initial approval to a proposed spending plan for the fiscal year that begins July 1.

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)

The Republican Majority twice rejected amendments that would have built federal money to expand eligibility for Medicaid into the budget. Both efforts were offered by Representative Jill Schupp (D-Creve Coeur).

“Ladies and gentlemen when rural hospitals close, actions here today will be remembered,” Schupp told the House before reading a list of groups that support Medicaid expansion. “There is only one group that is opposing it, and that group is right here in the Missouri legislature. It’s time to move forward.”

Schupp says Missouri’s failure to expand Medicaid means federal tax dollars coming from this state are going to other states. Representative Keith Frederick (R-Rolla) says he’s “kinda tired” of hearing that argument.

“That would be to imply that if we expand Medicaid we will deprive other states of the funds necessary for them to expand their Medicaid program and nothing could be further from the truth,” says Frederick. He argues that the federal government is creating further debt for the U.S. by offering to pay for Medicaid expansion in states.

The budget proposal uses a two-tiered approach 

The House also approved two amendments that would pull funding from the Department of Elementary and Secondary Education for common core standards, and the Republican Majority rejected an amendment to strip $6-million from the budget for a possible state takeover of the Ozark National Scenic Riverways.

The House is expected to send the full budget to the Senate later this week.

View the House budget bills

House takes up Budget Debate today

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The Missouri House will debate the proposed budget for the fiscal year beginning July 1 today.

The proposal is split between two funds because the Governor and legislative budget makers didn’t agree on an estimate of revenue for fiscal year 2015. It would draw from General Revenue the expenditures Senate and House leaders believe the state will have enough revenue for and would use a new, separate “surplus revenue fund,” to pay for anything beyond that, that Governor Jay Nixon (D) thinks there will be revenue for.

Representative Jill Schupp (D-Creve Coeur) has filed an amendment that would accept federal dollars for Medicaid expansion. She offered such an amendment in the House Budget Committee but it was voted down by the Committee’s Republicans.

Earlier story:  House Budget Committee approves two-tiered budget plan

House Republican Medicaid plan sponsor undeterred by Senate Republican comments

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Work will continue on a House Republican proposal that would reform Medicaid and expand eligibility in Missouri, despite Senate Republicans reaffirming their opposition to Medicaid expansion. A House Committee will hold its third hearing on the proposal, HB 1901 sponsored by Representative Noel Torpey (R-Independence), early Tuesday in the basement of the Capitol.

“There is no path for Medicaid expansion to occur in Missouri this year,” said Brad Lager (R-Savannah) on Monday, one of five Republican Senators who said they would block any attempt to expand Medicaid eligibility this session.

“If we’re going to allow five people to run the state, that’s unfortunate,” says Torpey. He agrees that expansion by itself will not succeed in the Republican-controlled Missouri legislature.

“That was evident last year,” Torpey tells Missourinet, “but if people want reform and truly want reform, we’re going to have to do some type of eligibility changes, and so they’re linked together.”

Torpey says the Senators’ comments won’t cause him to do anything differently.

“Things can change in politics in a day, let alone eight weeks,” says Torpey.

House Speaker Tim Jones (R-Eureka) says the opposition to expansion is not limited to the Senate.

“The signals I’m receiving from the (House Republican) caucus and the signals I’m receiving from the Senate are that expansion is simply something that the legislature does not have much of an appetite for this year,” Jones says. “They’re very concerned about the long-term effects on the budget, and I share those concerns.”

Torpey thinks stripping out the expansion components of his legislation would not be successful either.

“I really think it’s a partnership,” says Torpey of reform and expansion of Medicaid. “We get both or nothing.”

The hearing Tuesday will focus on three aspects of Torpey’s bill, including increased eligibility in some populations.

Earlier stories:

Hearing highlights work requirement, premium in House Republican Medicaid plan

House Republican files Medicaid expansion, reform proposal

Hearings continue on proposed Medicaid reform, expansion plan

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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