Missouri Lawmakers Finally Vote On Medicaid Expansion
In what Missouri House Insurance Committee Chairman Chris Molendorp acknowledged was a symbolic move, a Medicaid expansion measure gained its first committee endorsement of the year last week.
Molendorp, R-Belton, and the four Democrats on his committee combined to recommend a wide-ranging bill that would expand the public health insurance system to about 300,000 low-income adults. The vote was 5-2, with five Republicans absent.
"If it makes people mad, what are they going to do, not vote for me?" said Molendorp, who is not seeking re-election. "I'm just going to stick it on any bill I've got left" in the insurance committee.
The 121-page proposal adopted by the committee is modeled on a plan developed by Sen. Ryan Silvey, R-Kansas City. It attempts to address GOP opposition to Medicaid expansion by requiring a host of changes, such as photo IDs for food stamp recipients and more transparent billing practices for hospitals.
But with only 11 days left in the legislative session and GOP leaders opposed to the bill, it's unlikely to go any further. Molendorp acknowledged as much after the committee vote.
"You know, I've got these bills in my possession. I thought it makes sense to make a statement that the Republican Party needs to do the right thing, and this is all I can do as part of a voice in the wilderness in my party.
"So it's symbolic and I understand that, but someone's got to lead on this issue. I know it's not going to go anywhere," Molendorp said.
Then he was interrupted by Medicaid supporters who urged him to be more optimistic.
"This is an incredible proposal that I'm sure will be adopted swiftly by House leadership. How's that?" he quipped.
The bill would set aside savings the state expects to gain by shifting some people who are currently on state-funded health care or traditional Medicaid into the expanded Medicaid coverage group.
The expansion group includes working-age adults earning up to 138% of the federal poverty level, or roughly $27,310 for a family of three.
While Missouri receives about 60% funding from the federal government for traditional Medicaid patients, those covered under the expansion would be paid 100 percent by the federal government initially, dropping to a 90% federal share by 2020.
Silvey estimates the state's savings could add up to $600 million by 2019. He said the state's tab for the newly eligible recipients could be roughly $200 million a year when it hits the 10 percent level.
If there wasn't enough money in the "lockbox" account to pay the bills for the new Medicaid participants, Silvey's plan would cover the balance by reducing the rates paid to medical providers, such as hospitals. He includes a five-year sunset clause, which means coverage would lapse for the newly covered adults unless the Legislature chose to renew it.
During the meeting Democrats expressed enthusiastic support for the bill, including a provision that would expand coverage to pregnant women making up to three times the poverty level.
"It's a pro-life vote," Molendorp exclaimed. "We've got some dental stuff in here. I think I got rid of term limits, too," he joked. "There's a lot of good stuff in here. Trust me."
Rep. Jill Schupp, D-Creve Coeur, praised Molendorp.
"I think it's great that he's doing it," she said. "I wish it was more likely to move forward."
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.
