JEFFERSON CITY, Mo. (AP) — Missouri House Republicans gave a resounding "no" Monday to Democratic plans to expand Medicaid coverage in a strategic preview to the unveiling of an alternative plan touted to transform the state's health care program for the poor into "the most free-market-based Medicaid system in the entire country."
Two separate House committees simultaneously heard arguments for — and then rejected — proposals to adopt a central component of President Barack Obama's health care law that could have eventually extended government-funded Medicaid coverage to an additional 300,000 lower-income adults in Missouri.
A House appropriations committee shot down an attempt to add funding for the Medicaid expansion to the 2014 budget. Meanwhile, a House government oversight panel defeated a measure that would have put the Medicaid expansion into state law. Both committees voted along party lines, with Republicans opposing the Medicaid expansion and Democrats supporting it.
Democratic Gov. Jay Nixon has supported the Medicaid expansion as "the smart thing" and "the right thing to do" — both for the health of Missouri residents and to ensure Missouri gets its multi-billion-dollar share of federal money pledged to states that expand eligibility to 138 percent of the federal poverty level, or $32,499 annually for a family of four. Democrats also have pointed to a study for the Missouri Hospital Association concluding that the federal Medicaid money could create 24,000 jobs in Missouri.
Republican governors in some states, including Florida and Ohio, have embraced the expansion. But Missouri Republicans have remained reluctant, citing philosophical objections to expanding "welfare" and concerns that that federal government can't afford to follow through on its funding plan.
Rep. Jay Barnes derided the Democrats' plan as the "Brink's truck theory of economic development, where we ask the federal government to send as many Brink's trucks full of borrowed cash from China as they can possibly gather and dump it into Missouri's economy."
Barnes, who is chairman of the House Government Oversight and Accountability Committee, plans to introduce an alternative plan Tuesday that would expand Medicaid coverage to some people, cut others off the program, require participants to pay more out-of-pocket and "inject competition" into Medicaid health care plans.
"I think there is a genuine interest ... in finding ways to transform Missouri's Medicaid system to make it the most free-market-based Medicaid system in the entire country," said Barnes, R-Jefferson City.
Republicans rejected the Democratic plan modeled on Obama's health care law with unusual efficiency — hearing testimony from more than 30 witnesses supporting it, and one opponent, and then immediately voting down the legislation in Barnes' committee. Missouri legislative committees typically wait a week or more to vote on legislation after hearing testimony.
Those supporting the Democrats' Medicaid expansion included representatives of social services, health care and business organizations, including some who typically support Republicans. They noted that under the federal health care law, hospitals are to receive less money for treating Medicare and uninsured patients on the assumption that they will get more money under an expanded Medicaid roll.
If Medicaid is not expanded, hospitals could take a financial hit and seek to recoup some of their lost money through higher bills to insurance companies.
"This is something that now becomes a dollars and sense issue for the employers of our state," said Ray McCarty, president of Associated Industries of Missouri. "We agree what the federal government has done really amounts to extortion. Unfortunately, we're the ones who are going to have to pay if we don't do anything."
The federal Congressional Budget Office has projected that the Affordable Care Act would reduce the federal deficit — a fact that some witnesses noted was contrary to Barnes' analogy of borrowing a truckload of money from China to pay for it.
For the sake argument, House Minority Leader Jake Hummel embraced Barnes' analogy.
"The Brink's truck is leaving Washington and heading to other states," said Hummel, R-St. Louis. "I would like the Brink's truck to stop in this state and create jobs in this state, instead of just filling up their tank of gas."
Associated Press writer Jordan Shapiro contributed to this report.
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