Medicaid debate fireworks begin as House passes 2014 budget

See Related Stories

JEFFERSON CITY - Debate over whether to expand the state's Medicaid program flared up quickly this week as the state House of Representatives finished its initial work in a crafting Missouri's budget for the coming fiscal year.

In a series of 13 votes on Thursday, March 28, House members sent their spending plan on to the Senate. Both legislative chambers will have to agree on a final balanced budget before their regular legislative session ends in mid-May.

Throughout the week, several House Democrats chastised their Republican counterparts for leaving the Medicaid expansion out of their proposed budget, which totals about $24.8 billion.

The expansion is a key part of implementing the federal health care law passed in 2009 because it is supposed to make it easier for the state's poorer people to obtain health insurance coverage. Federal guidelines say Missouri's Medicaid program needs to cover people with incomes lower than $32,500 for a family of four.

Broadening the Medicaid program's eligibility criteria has been the focus of both Democratic lawmakers and Gov. Jay Nixon since the beginning of the year. They argue that the expansion wouldn't hit Missouri's budget right away, because the federal government is to cover any additional costs associated with its expansion for the first three years.

Nixon has been barnstorming the state, meeting with business groups and hospitals to try and put pressure on Republican lawmakers from their home districts.

The governor and the Democratic lawmakers have said that local hospitals could start losing some of their federal health care money if the Medicaid expansion isn't enacted this year. They've said that could put a serious squeeze on hospitals' balance sheets, especially in rural areas.

And Democrats like Rep. Jeff Roorda said this week that not doing the expansion means Missouri will have to forgo about $940 million in federal funds this year. They said that money will instead flow to other states that are already implementing bigger Medicaid programs.

"We shouldn't be leaving rural hospitals out in the cold." said Roorda, D-Barnhart. "We shouldn't be leaving our economy out in the cold. We've turned our back on our own money that we've sent up to the federal government."

On Tuesday, Roorda moved to send part of the spending plan back to the House Budget Committee so that the expansion plan could be reconsidered, but that motion failed in a vote of 110-47, mostly along party lines. Later that same day, the House struck down an amendment explicitly inserting the expansion into the budget by a similar margin. That latter vote came after nearly an hour of emotional, high-strung debate that had members from both parties yelling at each other and at least one Democrat storming from the chamber in frustration.

Republicans said they're opposed to the expansion mainly because of its potential cost. The federal health care law calls for Missouri to start paying for a portion of the Medicaid expansion's cost after its first three years.

And GOP lawmakers, like Rep. Todd Richardson, said this week they're afraid that could cause Missouri's health care spending to skyrocket and could force legislators to make big cuts to other parts of the budget, such as education spending.

"We didn't create this problem," said Richardson, R-Poplar Bluff. "This is a problem that was created for us by a centrally-planned health care system that isn't the right solution for Missouri."

Republican-controlled committees in both the House and Senate have voted down Democratic legislative proposals to expand the Medicaid program.

A House committee heard testimony Monday on Republican-backed proposal that would expand the eligibility criteria for Medicaid, but that would ultimately decrease the number of people enrolled in the program. But that measure might not be far enough along in the legislative process to actually pass by the end of the session. And that Republican proposal carries an annual price tag of about $8 million per year, because Missouri wouldn't qualify for federal reimbursement with that plan.

The House also gave final approval Thursday to $219 million in additional state spending for this year, in a broadly bipartisan vote.

The measure is spending in addition to the $24 billion budget lawmakers approved last year. About 69 percent of the supplemental measure comes from federal dollars, with about 10 percent coming from Missouri tax dollars. Most of the money in the bill goes to the state's K-12 schools and services for people with disabilities. The largest state-funded expense is $17.1 million for payments by the Department of Mental Health.

That supplemental budget bill now goes to Democratic Gov. Jay Nixon, who is expected to sign it into law.