Health Care In The States

Missouri Governor Pushes GOP-Led Legislature On Medicaid Expansion

By Virginia Young, St. Louis Post-Dispatch

January 2nd, 2014, 4:06 PM

This story was produced in partnership with the

Missouri Gov. Jay Nixon, a Democrat, is intensifying his effort to persuade Republican lawmakers to expand Medicaid with a pitch that uses some of the same themes that Republicans favor.

At a news conference in his Capitol office this week, Nixon praised states such as Iowa and Arkansas for designing “common-sense, market-based approaches” that encourage personal responsibility on the part of Medicaid participants.

Those states “have seized this opportunity to implement innovative reforms, like rewards for making healthier lifestyle choices and penalties for missing doctors’ appointments or showing up at the emergency room with a stuffy nose,” Nixon said.

The governor and a coalition of business, labor and health care groups pushed during the last legislative session to expand Medicaid to the working poor, but the bill was shelved by the Republican-led Legislature. Critics said Medicaid is a broken, inefficient system and the federal government can’t be trusted to keep its promise to fund the expanded program.

Nixon said the dynamics will be different this year because the federal government will, in fact, be financing the expansion in states that accepted it. A recent study estimated that Missouri will turn away $2.2 billion in federal funds annually.

“As of 12:01 tonight … Missouri’s tax dollars are going to be used in New Jersey, Iowa, Arkansas and other parts of the country to solve their problems, and that’s not the way we like to do things in our state,” Nixon said.

Under the Affordable Care Act, the federal government will pay most of the cost to insure working-age people who make up to 138 percent of the federal poverty level, or $32,500 for a family of four.

Federal money will cover the tab for newly eligible participants the first three years, with states phasing in up to a 10 percent share of the cost after that.

Currently, Medicaid covers more than 875,000 Missourians — low-income seniors, people with disabilities and some families with children. Opponents say that even without expanding eligibility, the program’s cost to the state rises by $71 million a year.

“Missouri’s Medicaid system is already expanding at an unsustainable rate,” House Social Services Appropriations Chairwoman Sue Allen, R-Town and Country, wrote in a recent newsletter.

Whether Nixon and opponents can find any middle ground appears to be a long shot.

Rep. Jay Barnes, R-Jefferson City, drew up a proposal that would place people below the poverty level in the traditional Medicaid program and cover those making up to 138 percent of poverty by paying their premiums for private insurance.

But the House Interim Committee on Medicaid Transformation, which Barnes chairs, was cool to the idea and has not issued any recommendations.

So far, Nixon and legislators haven’t even been able to agree on a format for a joint brainstorming session.

Nixon invited House and Senate committees studying Medicaid to a round-table summit in November. But he canceled it after legislators decided to treat the meeting as a legislative hearing, where Nixon would testify and answer their questions.

“Governors don’t do that,” Nixon said testily in answer to a reporter’s question about why the summit fell through. “We wanted to have, and I still look forward to having, a thoughtful discussion. This is not a gotcha moment for either side.”

5 Responses to “Missouri Governor Pushes GOP-Led Legislature On Medicaid Expansion”

  1. Dave says:

    Republicans are neanderthals. That’s not changing anytime soon.

  2. pam says:


    I could not agree with you more. I no longer recognize the party that I joined many years ago. GOP officials have allowed the Republican Party to be hijacked by rural crazy people. Shutting down the government just because they can’t have 100 percent of what they want is simply insane. Forcing the government to default on debts they already approved is lunacy. The GOP has gone nuts and there’s no sign of any recovery.

  3. States that said “no” to Medicaid expansion, will find themselves with a larger problem over time. Another piece of the law (which was formulated when it was thought that the Medicaid expansion would be nationwide), took away subsidies for “safety net” hospitals this year. These are facilities that care for the poor, indigent & uninsured. Now that they’ll lose the subsidies to care for these people, they will have to turn people away, or close emergency room facilities. Some hospitals in Georgia have already closed from what’s been reported. People who would have been covered by the expansion still have no insurance coverage, since they do not qualify for Medicaid and they don’t make enough to take advantage of the advanced tax credit that the law uses to subsidize insurance premiums. This “Medicaid Gap” will prove to be costly in the long run since people won’t seek care until it’s reactive care and most likely are hospitalized or end up with a chronic condition. This group of people (the “working poor” as many call them) are the very group that we really wanted to have covered in the first place. Instead, they’ll be left out in the cold again, while we give subsidies to people who make $45,000/year. What???? Seems to make no sense to me. . . . .

  4. Tim says:

    A majority of the people who would be provided with healthcare under the expansion Medicaid are completely oblivious of it. They don’t pay attention to the news, they don’t vote en masse, and when they do vote it is usually for the very Republican jerks who are refusing to accept the expansion. “God and guns!” they cry. We don’t just have ignorant a-holes in Jefferson City; we have a whole bloody state full of them.

  5. Tim Koster says:

    The dang Republicans don’t understand that everyone needs to share the wealth a little bit. People should have a right to good health care, food, and other necessities such as a good cell phone, car and entertainment.