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Medicaid committee hears testimony, information on Arkansas model


JEFFERSON CITY, Mo. — The House Interim Committee on Medicaid Transformation has a difficult task. The Committee, chaired by Rep. Jay Barnes, R-Jefferson City, is tasked with making recommendations, even possibly offering legislation, on the politically charged subject of Medicaid expansion.

Whether or not Missouri should expand Medicaid eligibility to those making 133 percent of the Federal poverty level — as called for by the Patient Protection and Affordable Care Act — was a subject of major debate in Missouri during the last legislative session.

Committee members listen to testimony at Medicaid Transformation hearing.
Committee members listen to testimony at Medicaid Transformation hearing.

Democrats, including Gov. Jay Nixon, have argued expansion will lower healthcare costs by reducing emergency room visits and provide coverage for the working poor. Republicans in Missouri have largely opposed the expansion because of its symbolism as a tacit endorsement of “Obamacare,” as well as concerns that the expansion could leave the state holding the bill should the Federal government not meet its financial obligations associated with expansion.

The discussions in Tuesday’s committee hearing barely mentioned the word “Medicaid,” and focused largely on different facets of the health care and insurance business that could be streamlined through targeted reforms. Barnes has hinted in recent weeks toward his support of a hybrid form of Medicaid expansion. Based largely on legislation passed in neighboring Arkansas, some conservative states are expanding Medicaid with a marketplace compromise.

In laymen’s terms, the Arkansas model allows those making 133 percent of the Federal poverty level to be eligible for Medicaid or an equivalent plan offered at a discount by a private insurance company. Using Federal dollars intended for the Medicaid program, states like Arkansas are providing some of those funds to private insurers so they may “compete,” with various Medicaid options. The compromise allows eligible citizens to seek either a Medicaid healthcare plan, or a private insurance plan providing the same basic level of coverage at essentially the same cost.

The plan represents a compromise between Democrats supporting state-funded options for the most vulnerable working poor and Republicans arguing private insurance companies provide care in a more efficient way.

“There are a number of ways that we can reduce costs,” Rep. Chris Molendorp, R-Belton, says. “Consider wraparound services, those are things not always covered. If you are on dialysis and it’s covered, your transportation to the clinic may not be something your insurance provides. Missing that appointment is a serious thing, and the resulting cost to a provider is significant.”

Reforms have also focused on states like Indiana, where the eligibility for Medicaid was expanded to 200 percent of the poverty level in 2007, before the ACA even passed. In that state, many reforms were included in a package with expanded Medicaid eligibility including healthcare accounts to incentivize psotiive-health behavior and specific requirements for coverage for private companies.

The committee will also be meeting tomorrow morning. Barnes said his committee was tasking with offering “recommendations,” but that he personally hoped to have enough of a consensus to offer a bill before the beginning of the 2014 legislative session in January.