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Senate leader wants tort reform with Medicaid legislation

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The Majority Leader in the Senate says he doesn’t think legislation that expands Medicaid will get anywhere in his chamber in 2014. Senator Ron Richard (R-Joplin) says if it does, he wants tort reform with it.

Senator Ron Richard

Senator Ron Richard

Richard tells Missourinet, “I don’t think there’s a lot of support for Medicaid expansion. At least, there’s nobody in the Senate calling me that we want to expand Medicaid. All I’m hearing is that if we get Medicaid expansion from the House they’re going to slow it down.” Richard continues, “I don’t know if there’s room for a compromise on this or not. All I’m saying … if there is a compromise I would like to see tort reform be a part of it.”

Representative Jay Barnes (R-Jefferson City) is the Chairman of the House Interim Committee on Medicaid Transformation. He just presented to that Committee his proposal for Medicaid reform that attempts to save the state money over the life of Medicaid expansion. He says tort reform faces its own challenges.

“There’s a problem with the constitutionality of some of the measures that have been proposed thus far,” Barnes says. He notes the Supreme Court last year threw out a 2005 tort reform law. “That ruling is still there, so that’s an obvious issue that supporters need to figure out.”

The legislature overturned Governor Jay Nixon’s vetoes of three pieces of tort legislation in September’s veto session.

Richard says he hasn’t started developing an approach to tort reform legislation for 2014. “The fact that the Supreme Court took off the limits and we almost had the same limits as Kansas and the Supreme Court upheld it, that’s putting outstate Missouri at a disadvantage,” says Richard. “We’ve got medical facilities being built right across the borders and putting hospitals at a disadvantage in Missouri.”

He says he isn’t only looking at medical issues. “Doctors and nurses aren’t the only ones that need some relief from frivolous lawsuits.”

The Senate Interim Committee on Medicaid Transformation and Reform will meet Wednesday. Barnes’ House Committee meets again November 19. Both committees have been asked to meet in a joint session with Governor Nixon November 26.

Plan to save money on Medicaid expansion would mean reduced eligibility to children

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Some state lawmakers are balking at the concept of saving the state money to expand Medicaid by eliminating coverage for some children.

Representative Jay Barnes (right) presents concepts for reform of Medicaid to the Interim Committee on Medicaid Transformation.

Representative Jay Barnes (right) presents concepts for reform of Medicaid to the Interim Committee on Medicaid Transformation.

Representative Jay Barnes (R-Jefferson City) has outlined his idea to the House Interim Committee on Medicaid Transformation, which he chairs, to increase Medicaid eligibility enough to draw federal dollars as Democrats have wanted to do. To do it, he proposes the elimination or reduction of coverage for some groups including some children in low- to middle-income families.

Barnes calls the State Children’s Health Insurance Program (S-CHIP), “more liberal than the Affordable Care Act,” and he says that is why the state can pare it back. It currently extends coverage to children in families with income that is up to three-times the federal poverty level.

Barnes notes that families making more than one-and-a-half times the federal poverty level pay a premium on S-CHIP coverage, and says it would cost less for those families to buy a federally subsidized health insurance program on an exchange.

Representative Sue Allen (R-Town and Country) says she would rather continue the coverage to families whose spending habits are based on having it.

“We take care of children now better than some able-bodied adults,” she says. “Children have no way control or ability to impact the way a parent or two parents utilize their family resources.”

Representative Keith Frederick (R-Rolla) expresses his concern that Barnes’ plan would free up money in the state budget at the expense of piling on to the nation’s debt.

Representatives Keith Frederick (left) and Jay Barnes.

Representatives Keith Frederick (left) and Jay Barnes.

“The savings to us is by virtue of offloading the expense to basically our future generations. That’s a philosophic difficulty for me. If we carry it out to its logical conclusion, then in every instance that a state or any entity can save money if they offload it to the exchanges, they save money in their own little world, but as a nation it sinks us.”

Representative Chris Kelly (D-Columbia) responded to Frederick, noting the origin of Medicaid, “We are unloading our cost from one aspect of a federal program to a different aspect of a federal program. Missouri didn’t invent our current Medicaid scheme. The feds did. Now the feds are saying, ‘You can do this differently and we’ll pick up more of the cost.”

Barnes defended the concept. He tells the committee, “I’m comfortable with saying the State of Missouri should not pay for health insurance for a family that makes 300-percent of the federal poverty level.”

Barnes says a bill could be ready by some time in January. His overall plan would also eliminate or reduce coverage in the areas of care for the blind and women’s health, and projects a savings by Fiscal Year 2021 of more than $42-million.

His committee will meet again November 19, and then with its Senate counterpart and the Governor November 26.

Release of Republican plan for Medicaid overhaul could come this week

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The sponsor of a Republican proposal last session to reform and expand Medicaid is nearly ready to unveil a first draft of the new version of that bill.

Jay Barnes (left) is named Chairman of the Interim Committee on Medicaid Transformation by House Speaker Tim Jones (right). (Photo courtesy; Tim Bommel, Missouri House Communications.)

Jay Barnes (left) is named Chairman of the Interim Committee on Medicaid Transformation by House Speaker Tim Jones (right). (Photo courtesy; Tim Bommel, Missouri House Communications.)

Last session Representative Jay Barnes (R-Jefferson City) proposed an overhaul to expand Medicaid eligibility for some and offered incentives for recipients for keeping their costs low, while putting others on subsidized private insurance.

Barnes says he could release a first draft of a bill for 2014 this week, and it will share some of the same concepts.

“We want to give Missouri the most market-based Medicaid system in the entire country. We want to turn recipients of Medicaid into active consumers who are participants in their own health care decisions and give them skin in the game just like every other Missourian on private health insurance has, to bring down costs and actually improve the results of care.”

Barnes chairs an interim committee on Medicaid reform and expansion. He says it will have a chance to pick apart his proposal, piece-by-piece.

“I’m not going to file a bill until this committee is over … and it that means I don’t file a bill until January, that’s what it means.”

Barnes says he believes Missouri can still access federal money for Medicaid expansion, and he thinks there is more than one way that can happen.

“We need a model that’s Missouri-specific … different from any other state. There’s a way to get there. We can increase this new, market-based Medicaid to 100 percent of the federal poverty level and then help subsidize health care plans for working Missourians between 100 percent and 138 percent of the federal poverty level.”

The proposal will be unveiled online. The Interim Committee on Medicaid Transformation’s next meeting is October 26 at 1:00 at the State Capitol.

House announces two interim Medicaid committees (VIDEO)

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The House Speaker wants your help in finalizing the membership of a committee that will weigh what the future of Medicaid in Missouri should be. 

House Speaker Tim Jones (center) announces an interim committee to be chaired by Representative Jay Barnes (left) and a working group to be chaired by Representative Noel Torpey (right). (photo courtesy; Tim Bommel, Missouri House Communications)

House Speaker Tim Jones (center) announces an interim committee to be chaired by Representative Jay Barnes (left) and a working group to be chaired by Representative Noel Torpey (right). (photo courtesy; Tim Bommel, Missouri House Communications)

Representative Tim Jones (R-Eureka) has announced two new groups to consider Medicaid reform and/or expansion. One of them, the Citizens and Legislators Working Group on Medicaid Eligibility and Reform, will be made up of citizens and legislators taking testimony and other information to be used by the second, the House Interim Committee on Medicaid Transformation when it compiles recommendations to be made to the Republican majority caucus.

Jones wants Missourians to help decide how big the Working Group will be and who will be on it.

“Over the course of the next week my office will take membership recommendations from the general public of the entire state of Missouri for the committee … my hope is that Missourians from all parts of the state will reach out with any suggestions they have for members. We already have an ever-expanding and growing list of interested folks from all different, diverse walks of life and from across the state.”

Jones says he wants that Working Group to dig deep into the details of Missouri’s possible future with the Medicaid program.

“To provide citizen-generated ideas and solutions to a problem that has been often dominated by discussions related to dollar signs and false promises of free money rather than doing what is best for the people who most desperately need this care.”

Jones used the announcement of the committees to re-state his opposition to a simple expansion of the current Medicaid system.

“We see, and I believe Missourians see, expansion without reform as a massive misuse of taxpayer dollars on a program that provides inferior access to healthcare and poor health outcomes … and if we dump hundreds of thousands of additional uninsured people into that system and give them a magical plastic card and simply say, ‘Well now you have free healthcare,’ we will further drive an already broken system into a bankrupt state.”

The Working Group will be chaired by Representative Noel Torpey (R-Liberty) and the legislative interim committee will be chaired by Representative Jay Barnes (R-Jefferson City).

The Senate has also announced an interim committee on Medicaid, and a bill awaiting action by the Governor would create a joint legislative committee on the subject.

 

House to announce Medicaid committees this week

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Two Committees will be announced by the House Speaker this week that will look at Medicaid reform and expansion.

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

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

The larger of the two will be made up of a mix of representatives and individuals from the private sector that will travel the state and gather information from stakeholders. It will be chaired by Representative Noel Torpey (R-Independence). The other will be made up strictly of legislators and chaired by Representative Jay Barnes (R-Jefferson City).

House Speaker Tim Jones says the second committee will, “take advice and consent from the larger committee and then boil something down into solutions to the issue of Medicaid transformation.”

Jones says it is the latter committee that will be responsible for coming up with suggestions for the majority Republican caucus on how to proceed with the Medicaid issue.

Those on the two sides of the Medicaid expansion debate were split during the session on whether Missouri should expand eligibility to 138 percent of the poverty level. Republicans proposed a plan that called for reform and expansion to 100 percent. Jones says he will leave that issue completely up to the chairmen of the two committees.

“We’re going to have to see what kind of compromise can be struck. I think it’s an open question right now as to whether we only reform Medicaid and do no expansion … or at what level we expand it.”

The Senate has already announced its own 10-member committee to study possible Medicaid changes.

The two committees will be announced on Thursday.

 

Social Services welfare recipient shift scaled back (VIDEO)

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A contract between the Department of Social Services that came under fire from House Republicans has been restructured.

Representatives Sue Allen (left) and Jay Barnes (right) join House Speaker Tim Jones (center) and other House Republicans in announcing changes in a DSS contract the caucus had concerns with. (Photo courtesy; Tim Bommel, Missouri House Communications)

Representatives Sue Allen (left) and Jay Barnes (right) join House Speaker Tim Jones (center) and other House Republicans in announcing changes in a DSS contract the caucus had concerns with. (Photo courtesy; Tim Bommel, Missouri House Communications)

The contract with Boston-based Public Consulting Group outlined how it would look for people receiving state assistance that could be shifted to federal disability payments. Republicans said the original arrangement would have reached out to too many people, including children and those who could still work, and said it would have moved people off of welfare that requires recipients to actively look for jobs to a program where having a job could result in lowered benefits.

Representative Jay Barnes (R-Jefferson City) said documentation of the company’s proposed procedures raised concerns it would use aggressive tactics to get people to switch programs. He’s pleased with the new contract.

“For kids, who should not be in this process, they are no longer part of this contract, PCG will not be making cold calls to individuals, PCG will not be making any threats to those people already categorized as ‘disabled’ if they refuse to cooperate with this and PCG has agreed that they will have all phone calls recorded so that we can spot check what they’re doing.”

The new contract will limit the scope of the company’s search to people with disabilities and serious medical conditions.

The original contract would have also sought to move people whose transfer might have had to go to an appeals process because it would have been less clear the shift would be appropriate.

PCG will make $2,300 for every person moved off of Medicaid.

House Speaker Tim Jones (R-Eureka) commended Governor Jay Nixon and the Department for making these changes.

The situation came to light on a national radio program before PCG’s work began. Jones says it raises a question of whether such contracts need to be subject to legislative review earlier.

“There obviously needs to be some more oversight on these large-scale contracts that do affect thousands, if not millions, of Missourians.”

On the subject of oversight, Representative Sue Allen (R-Town and Country) says she told the Department’s representatives in a recent hearing of her Appropriations Committee she was surprised they didn’t bring the issue up.

“I do expect them to bring these issues to the committee and I had some anxt about that. That is an ongoing issue of trust … but they heard a very strong message and I think we got the good solution.”

See the House Republicans’ media conference below:

House committee hears update from State Budget Director

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The Nixon Administration has laid out its ideas for filling in the $460 million dollar hole in the fiscal year 2013 budget to the House Budget Committee.
 

State Budget Director Linda Luebbering

The gap in the budget had been $500 million but a recent mortgage settlement secured by the Attorney General’s Office has knocked that number down by $40 million.

State Budget Director Linda Luebbering says the Administration’s recommendations to balance the budget includes a $191.7 million reduction from where budget planners expected Medicaid would be. She tells lawmakers, “It’s an actual reduction of $20 million for general revenue from this year, but a $191 million dollar reduction from where we thought we would need to be because of the change in the Medicaid match rate.” Luebbering says it will not require a change in eligibility or a reduction in services provided.

$74.7 million of the administration’s budget recommendations also rely on measures still before the state legislature. A revenue collections bill would generate an estimated $12.9 million, with another $51.8 million to come from a tax amnesty bill. Both are sponsored by Representative Tom Flanigan (R-Carthage).

What had been a $16.9 million dollar recommended reduction to community and technical colleges has been scaled back to $10.5 million, also due to proceeds from the mortgage settlement.

Other amounts include $41 million from restructuring debt, $29.3 million in administrative savings, a $7 million reduction to biodiesel subsidy payments and a $2 million reduction to public health agencies.

The Administration’s top priority for the budget remains $203 million to the Foundation Formula. Luebbering says, “$198 million of that is needed just to keep the formula where it is this year.”

Luebbering tells the committee there are some positive signs in the economy. “The unemployment rate is down. We are starting to see a little bit of growth on the collections side. Not a lot yet this fiscal year. We were at 1.3 percent growth in our revenue collections at the end of January, so not stellar growth, but certainly it’s good to see that we’re continuing a positive on our collections numbers.”

Republicans question the validity of the lower unemployment numbers, saying that federal statistic does not count individuals who don’t have jobs and are no longer looking for them as being unemployed. Luebbering says the data still holds meaning, “Because it has historically looked at people who are looking for jobs or who have jobs. So, I think it is a historically relevant statistic that has been measured the same for years. Granted it’s not a complete number, but it at least is consistently calculated every month.”

The House Budget Committee will continue to hold agency budget hearings this week.

Health care overhaul passes without Missouri support

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A health care overhaul has passed the House in Washington without much help from Missouri’s Congressional delegation.

Democratic leaders in the House were able to convince enough reluctant Democrats to vote in favor of the measure to squeeze out a 220-215 vote and send the massive bill to the Senate. The vote came Saturday evening after President Obama delivered a pep talk to Democrats, urging them to “answer the call of history” and approve the trillion-dollar package. [Read more…]

Jefferson City awaits Washington health care outcome

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Health care will once again be a big topic of discussion when the legislature returns to Jefferson City in January, but that discussion could be shaped in large part by how health care legislation plays out in Washington.

State lawmakers are closely watching the developments in the health care debate in Washington. House Majority Floor Leader Steven Tilley (R-Perryville) says what Washington decides will have a big impact on what Jefferson City considers.

“With regards to health care, we need to get our hands around what they’re wanting to do at the federal level and then, hopefully, we can do something to dovetail it from here,” Tilley says. [Read more…]