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Republicans begin behind the scenes push for Medicaid expansion


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By Eli Yokley

JEFFERSON CITY, Mo. — Democrats supporting Medicaid expansion have pushed a united front — touting the proposal to expand the program’s rolls as the “smart thing to do” and the “right thing to do” economically and morally.

For Republicans who have largely opposed the proposal, a new poll suggests that despite their objections, it might be the smart thing for them to do politically.

American Viewpoints, a Virginia based polling firm that has worked for many statewide Republicans, conducted a survey early last month that found a plurality of Missourians — 47 precent to 37 percent — favor expansion, and that number rose to 56 percent when the subjects of the survey were offered a balanced set of arguments for and against the proposal.

The poll, commissioned by the Missouri Hospitals Association and reviewed by Randall Gutermunth and David Barklage for the Missouri Republican Legislative Caucuses, is part of a new strategy by expansion’s supporters to attempt to persuade weary Republicans to favor expansion. The key finding, they wrote, is “there are fights that will be had with the Governor, but this shouldn’t be one of them.”

According to the poll, independents and women overwhelmingly support the proposal. Expanding the program was initially opposed by those who had health care insurance, but their view swung significantly after they heard the balanced set of arguments. The poll also found that a conservative lawmaker supporting expansion is not necessarily a deal breaker for rural voters. Voters in rural State Senate districts, they found, support the proposal 51-39 percent after hearing the set of arguments.

Under the proposal pushed by Democrats and Gov. Jay Nixon, Medicaid would cover anyone under 134 percent of the federal poverty level — approximately 300,000 Missourians. The federal share of the program would be 100 percent until 2017, then gradually shift to 90 percent by 2020.

Nixon has toured the state in recent weeks touting the business aspect of the proposal. It is supported by the Missouri Chamber of Commerce and various business groups across the state, in part because of its probability to significantly boost spending in the state’s medical industry. A study commissioned by the Missouri Hospitals Association found that some 24,000 jobs could be created if Medicaid is expanded.

The strategists believe Republicans could use this opportunity to push reforms to the proposal, while nonetheless expanding the state’s Medicaid rolls. With packaged reforms, including improving technology to root out fraud and allowing lawmakers to opt-out of the changes when the federal share of the program begins to roll back in 2017, they said there is a good way for Republicans to message support of expansion.

Key lawmakers were briefed on the poll on Monday, and more will be briefed on it throughout the week. Nixon has not been shown the poll, but is quietly watching as friendly Republican faces go door to door on expansion’s behalf.

A similar memo is in the works to be presented to Democrats later this month.