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Opinion: Further Medicaid reforms needed now more than ever


Regardless of where you stand on Medicaid expansion, all of us can agree that Missouri’s Medicaid system is broken. Plagued by high costs and poor outcomes, our citizens deserve and have demanded better. But entrenched special interests and wealthy non-profits are now running off to court to try and prevent even the most common sense of Medicaid reforms from being enacted.

This year, Gov. Mike Parson and bipartisan supporters in the Missouri Legislature worked together to enact critical reforms to Missouri Medicaid. These reforms will partially replace a complicated and outdated system that paid different hospitals varied rates for the same procedures, based on their costs. For many years, they have been telling us how much to pay them with little consistency. This, of course, has contributed to an extremely inefficient Medicaid program.

State Rep. Cody Smith

Policymakers have moved to transition to a fee schedule for outpatient services. This mirrors Medicare and what many other states have done with their respective Medicaid programs. Our most recent budget will reimburse hospitals at 90 percent of the Medicare rate, thereby incentivizing the efficient and effective provision of care. This is a favorable reimbursement rate compared to many other states. For example, even budget-busting California only pays providers at about half the rate of Medicare, according to the Wall Street Journal.

Reforming state government is never easy — especially during times of uncertainty. A broad, bipartisan coalition in the House and Senate coordinated and compromised to modernize Missouri’s Medicaid program. In the Missouri House, we did so even after an organization, which is funded in part by the federal reimbursement allowance (FRA) and whose members oftentimes enjoy tax-exempt status, sent lawmakers a heavy-handed letter stating it, “very rarely treats floor votes as litmus test indicators of alignment with hospital interests … This will be a rated vote.”

Despite these not-so-subtle threats of withholding future political support, Democrats and Republicans came together and crafted a plan that put taxpayers and patients before special interests. Now, those same special interests have run to court with a last-minute lawsuit designed to block these needed reforms. They have even convinced a Cole County judge to issue a temporary restraining order that prevented these reforms from taking effect on July 1, thus causing a hit to the state budget.

Next legislative session, I intend to again work with Gov. Parson and bipartisan members of the House and Senate to pursue more reforms that improve care to Missouri’s working poor, while strengthening our state’s bottom line. For example, Missouri is currently the only state in the nation where out-of-state patients can be treated in a Missouri hospital with our taxpayers paying those costs. That ill-fated policy robs the Missouri budget of funds that could improve the care of recipients who actually live in Missouri. Yet, each and every year entrenched special interests use FRA funds and the fruits of their non-profit status to lobby against such changes.

Missouri deserves a health care system designed by its elected leaders — not trial lawyers. Ultimately, I am confident that common sense will prevail, and our state will enact the legislature’s plan for cost-effective, patient-centered care. The health of our citizens and our state budget depend on it.