The Kansas City Star, March 2
Listen to those who need Medicaid expansion
In the state capitols of Missouri and Kansas, elected officials dither over expanding Medicaid. For them, the debate is about numbers, future budgets, free market arguments, and the merits and flaws of the federal Affordable Care Act.
For Kierra Hawkins, it is about the fist-sized cyst on her right ovary.
Hawkins, a 23-year-old community college student in Kansas City, was at her job as an aide in a day-care center when acute stomach pains sent her to the hospital in late September. Tests detected the cyst, and found it was not cancerous. Still, doctors said it would need to be removed.
Hawkins skipped her follow-up doctor's visit. She is uninsured and couldn't afford the $350 initial copay, much less the entire bill.
Fortunately, Truman Medical Center has approved her application for a charity discount. Hawkins is to see a doctor this month.
Her cyst would have been detected in a routine gynecological exam, but she hasn't had one since age 18. Her job pays about $1,200 a month, and offers no health benefits. She has looked into insurance policies but finds them too expensive. ...
Hawkins is about 20 credits away from earning an associate's degree in early childhood education. She hopes that will propel her into a better-paying job with health benefits.
For now, an expansion of Medicaid limits to the threshold called for in the Affordable Care Act, 133 percent of the federal poverty level, would get her the care she needs.
In Missouri, Democratic Gov. Jay Nixon wants to expand Medicaid eligibility, while some in the Republican-controlled legislature are trying to insure more people with a market-based approach.
In Kansas, Republican Gov. Sam Brownback is mum on the topic, while key GOP lawmakers seem inclined to reject an expansion out of hand.
If the states don't raise eligibility, they will pass on billions of dollars of federal funding. Worse, they will create a new medical "doughnut hole," whereby people in a certain low-income range will continue to find health care unaffordable, while those with very low incomes qualify for Medicaid, and people with slightly higher incomes qualify for subsidies under the Affordable Care Act. ...
Around the nation, governors and legislators are putting aside political ideologies and realizing that, from fiscal and humane standpoints, expanding Medicaid limits is the right thing to do. For Missouri and Kansas to do otherwise would be cruel and irresponsible.
The Springfield News-Leader, March 2
Get moving on Medicaid
With the economic health of the state and the health care industry in the balance, it is time for the Missouri General Assembly to get serious about expanding Medicaid.
And it is time for voters to give their legislators a reason to step out and seriously consider opting into the federal government's Medicaid plan. In fact, it is up to voters to give their legislators the political cover they need to take that step.
While the majority of Missourians and Republican legislators have made it clear they don't like Obamacare, refusing the Medicaid expansion as a way to double down on that distaste is dangerous on many levels. ...
When the U.S. Supreme Court ruled that Obamacare is legal, but the mandate that states expand their Medicaid rolls was not, it changed the landscape. The federal government provided substantial incentives for states to participate, but some have continued to hold back, expressing both economic and political concerns.
Two important Republican governors — Chris Christie in New Jersey and Rick Scott in Florida — have recently changed their positions, which could be a harbinger of change around the country. But the political fallout for many Republican lawmakers has made accepting this important element of Obamacare difficult.
For those in the health care industry, not accepting expansion of Medicaid could be catastrophic because that first part of the deal — reduction in payments — is still part of the package. In fact, it has already started.
By the end of 2019, those cuts are predicted to total $4 billion to hospitals across the state. For CoxHealth alone, that cost could equal $47 million.
That level of cutting will have an impact. It will mean some hospitals, especially small ones in rural areas, will have to close, people will lose their jobs, hospitals will cut back on capital investments, and those of us who have private insurance will have to pay more. ...
On the other hand, if Missouri opts into Medicaid expansion, it will bring in a projected $15.7 billion in federal funding through 2021. The federal program provides for 100 percent federal funding in 2014-16, then dropping to 95 percent and ultimately 90 percent by 2020. ...
A University of Missouri at Columbia study predicts that expansion would also generate more than 24,000 jobs in 2014 — the first year the expansion is set to go into effect. Our region is predicted to get 13.8 percent of those jobs. ...
But money is not the only reason to embrace the expansion. People and their health are important reasons.
With the "working poor" representing more than half of Missouri's uninsured, we would be providing access to health care coverage to people who work in restaurants, construction, housekeeping, retail sales, agriculture, child care, even teachers and those in health care services. We know that insured workers are healthier workers and healthier neighbors.
Those nearly 107,000 workers who could benefit from the expansion would no longer have to use emergency rooms as their primary medical care, keeping costs down and making our ERs more effective for those who are experiencing a medical emergency.
And, that would lower the costs for everyone, especially those who pay for private insurance. ...
Jefferson City News Tribune, March 2
Shorter session does not advance good government
Good government is not dependent on a time element.
State Sen. John Lamping, R-Ladue, wants to trim the legislative session from 18 weeks to 12.
"The idea I had," Lamping said, "essentially, had most to do with just being more productive. Not wasting time, but making the best of the time that you have here."
Many jobs, including journalism, have deadlines, which means doing the best job possible in the allotted time.
Reducing the amount of time, however, does not necessarily translate into a better product.
Missouri voters in 1988 changed the Constitution to establish the regular legislative session from early January to the second full week in May each year, followed by a veto session in the second week of September.
Lamping's proposed amendment to the Constitution would establish the end of March as the conclusion of the regular session and move the veto session to June.
Is time wasted during the 18-week duration of the regular session?
The legislative process is complicated — sometimes convoluted.
Bill are introduced; committees established; information studied; hearings held; issues debated; amendments offered; votes taken; proposals advanced; conference committees formed; compromises sought.
Even under optimum conditions, the process involves lulls in the action — lulls that may be advantageous gather more information, hear additional arguments or simply ease intensity.
Recently in this forum, we cautioned lawmakers to avoid haste and to research issues thoroughly to avoid unintended consequences.
We see no advantage to shortening the legislative session.
Good government depends on the quality of leadership and representation, not the quantity of time spent.
The St. Joseph News-Press, Feb. 28
Update voting rules
Requiring someone to show a photo ID when voting is not the evil some have made it out to be. Neither is widespread early voting.
Close observers of the political scene in Missouri know this but others may be unaware: These two issues are stalled because neither political party wants to let the other's proposal become law.
Democrats fear Republicans will keep Democrat party loyalists from voting if a photo ID becomes a requirement. The thinking is older voters in the inner cities would be among those potentially the most affected, and many of those voters are Democrats.
Republicans fear Democrats will try to use an expanded voting period to pack the polls with Democrats. The thinking is Republicans lose an advantage when the rules allow ballots from those who otherwise might not make it to the polls on Election Day.
We see problems with both positions. Our views:
Approve photo ID for voting: Anyone legally entitled to vote should appreciate efforts to ensure the integrity of the ballot box. We do not require evidence of previous widespread fraud to appreciate the merits of this requirement.
In this day and age, it is not asking too much for adult citizens to be prepared to present a photo ID at their polling place. For that small number of citizens who might lack such a common piece of identification, a reasonable law will make provisions to assist them in obtaining an ID without denying them the chance to vote.
Approve expanded early voting: Use Thursday's report from the statewide Early Voting Commission as a starting point. This group, convened by Secretary of State Jason Kander, comes with the baggage that Kander is a Democrat. But the provisions it advances appear reasonable, accommodate voters of both parties and would bring Missouri in line with 35 other states on this subject.
The recommendations would retain protections of current law while allowing registered voters to cast absentee ballots by mail without needing to state an excuse; allowing early ballots to be cast in-person on electronic voting equipment at a central voting location; and aligning the period of in-person early voting with the current absentee ballot period.