JEFFERSON CITY, Mo. – While several red states have decided to review whether or not to expand Medicaid under the Affordable Care Act (ACA) following the failure of Congress last week to repeal and replace the controversial law, Republican leaders in Missouri have made it known Medicaid expansion will not take place in the Show-Me State.

Gov. Eric Greitens, who would ultimately have to sign off on such a measure, emphatically said he would not sign a bill to expand Medicaid in Missouri.

“I still believe we need to repeal and to replace Obamacare,” he said Tuesday at a press availability.

Last week, Greitens and numerous other Republican governors signed a letter to support the American Health Care Act, a proposed alternative to the ACA, better known as Obamacare.

Speaker of the House Paul Ryan, withdrew the bill after determining it did not have enough support in the House to pass on to the Senate, where it also would have faced a serious test. The failure of that bill to proceed was deemed a big stumble for Republicans in Washington, who control both chambers of Congress and the presidency.

Greitens signed the letter with the other conservative governors just a day before Ryan rescinded the bill.

Medicaid expansion

While talks have renewed in Washington of a potential new health care bill in the works that will pass muster in the House, other states, including neighboring Kansas, have looked towards expanding Medicaid in their states. Under Obamacare, states receive funds from the federal government to expand Medicaid coverage to people living from 100 percent to 133 percent of the poverty level, individuals making between roughly $10,000 to $16,000. Political leaders in Maine, Virginia, and Georgia, including conservatives, have also indicated their willingness to reconsider not expanding Medicaid.

Kansas’ Senate actually voted Tuesday to expand Medicaid, and their House approved the measure earlier in the year.

Democratic Sen. Scott Sifton of Affton said Missouri should follow suit.

“With complete Republican control of the legislature, there is no reason for Gov. Greitens to delay common sense Medicaid reform, especially while Republican-controlled states like Kansas move forward,” he said in a statement. “Failing to act will only hurt working families in Missouri who are struggling to put food on the table and make ends meet.”

Sen. Jill Schupp, D-St. Louis, has a bill already filed to expand Medicaid in the state, but it has yet to receive a hearing in the Senate Health and Pensions Committee.

The idea of expansion is to provide more care to those most at risk, however, opponents of expansion argue it drastically increases costs for states. While Ohio has lauded its own Medicaid expansion under Republican Gov. John Kasich, it has raised costs.

“It actually really busted those budgets,” Greitens said. “When you look at the budget in the state of Missouri, we spend more money on health care than we do on higher education, K-12 education, our entire justice system, everything we spend on domestic violence prevention, programs for veterans, everything we spend on health care is more than all of those other programs combined.”

Kansas Gov. Sam Brownback also opposed efforts in Kansas to expand coverage, according to the Kansas City Star.

Other alternatives?

Greitens did entertain the possibility of alternatives and innovations to increase healthcare coverage, such as those used by Indiana when then-Gov. Mike Pence approved Medicaid expansion in that state. Critics have derided some of the caveats and changes for Indiana’s Medicaid expansion plan for shifting costs for coverage onto those below the poverty line. On the other hand, Indiana also provides dental and vision coverage (rare for Medicaid in other states) and providers have flocked to the plan which raises doctors’ pay and rates for hospitals.

In a statement, Senate President Pro Tem Ron Richard also rejected the idea of expanding Medicaid for cost concerns but said the state legislature would continue to pursue methods to provide better access to health care.

“Missouri should be able to craft a sustainable program that fits our needs and priorities,” Richard said in a statement. “The Legislature has made great strides in finding ways to reduce costs and find better access to health care, and we will continue to look for other health care policy options. We will also continue to keep our eyes on the federal government as health care reform takes shape.”

Speaker Todd Richardson sounded the same note, saying it would hurt the state’s other spending priorities more than it already has.

“This legislative body has made it very clear that we are not willing to expand a broken system that is already growing at an unsustainable rate,” Richardson said. “To expand it further would be irresponsible.”