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GOP strategists join Nixon push for Medicaid expansion

By Eli Yokley

JEFFERSON CITY, Mo. — Expanding the state’s Medicaid rolls received a boost last week as some Republican strategists joined Gov. Jay Nixon’s push to expand the program to thousands of Missourians. Nixon Feature Image

Their efforts were emboldened by a new poll commissioned by the Missouri Hospital Association commissioned that asked Missourians where they stood on expansion.  For Republicans who are concerned about the political implications of expansion, the results were striking.  While Nixon has touted the plan as the right thing to do economically and morally, their poll shows it could also be the right thing to do politically.

American Viewpoint, a Virginia based polling firm that has worked for many statewide Republicans (including Sen. Roy Blunt, John Brunner, and party chairman Ed Martin), conducted a survey early last month that found a plurality of Missourians — 47 to 37 percent —  favor expansion, and that number rose 5 percent when those polled were offered an equal set of arguments for and against the proposal.

The poll, presented by Randall Gutermuth and David Barklage to the Missouri Republican Legislative Caucuses, is part of a new strategy by a handful of party operatives 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 — important voting blocks for the party as it attempts to win statewide seats during 2014 and 2016 —  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 equal 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 to 39-percent after hearing the set of arguments.

House Speaker Tim Jones said during a meeting with reporters last week that he takes every poll he sees with a grain of salt.

“I’m going to redirect anyone who is pointing to these polls to the only poll that really matters to the Missouri public, which was the vote on Proposition C [in 2010] and Proposition E [in 2012],” Jones said, pointing to two measures where Missourians opposed various provisions of the federal health care law. “All polls have to be considered in light of those decision by Missouri voters.”

Key lawmakers were briefed on the poll Monday, and more were briefed later during the week. That all happened before Nixon had even viewed the poll, individuals with knowledge of the process said. He instead quietly waited as friendly Republican faces went door to door on expansion’s behalf.

Through the proposal pushed by Democrats and Gov. Jay Nixon, Medicaid would cover anyone whose income is below 138 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 aspects of the proposal. His plan 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 Hospital 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.

To do that, there are various legislative vehicles on the table — including a proposal by state Rep. Jay Barnes, R-Jefferson City. His plan would expand the program to nearly 180,000 Missourians, but does not reach the 138 percent threshold required by federal law.

Jones said any proposal that his caucus could support would have to include reforms to how the funds are spent.

“I have not turned a blind eye to this,” he said. “There’s a lot of ways to skin the cat in the Medicaid game — it doesn’t all have to be taking free money from the federal government that can not be sustained in our budget for the long-term.”

Barnes, for example, has introduced legislation that would boot Missourians convicted of drug offenses from the program unless they seek rehabilitation treatment. His larger proposal would require a waiver from the federal government, which U.S. Sen. Claire McCaskill, D., believes would be hard to get.

“If they’re serious, I would hope they would reach out sooner rather than later about the details that they’re planning,” she said. “I think it doubtful that waivers are going to be given to people who say we’re not going to make a difference to the people that we’re serving.”

Speaking to supporters at a hospital in Jefferson City, Nixon touted recent improvements in the state’s economy, and added that he felt continued economic growth was tied directly to the health care decision currently facing the State.

“Making sure we continue to build on this progress has everything to do with how we move forward on health care,” he said. “This is not a political decision. It is an economic one.”

Nixon said his proposal to expand Medicaid would bring $5.7 billion the Missouri economy during the next six years.

“There are high costs to letting this pass by,” Nixon said, referring to the loss of some federal Medicaid money, higher insurance premiums and potential detriment to the State’s mental health care system: a key concern to Missouri law enforcement authorities in light of recent national shootings. “Inaction means more mentally unhealthy people are not getting treatment.”

To reach Eli Yokley, email or contact via Twitter at @eyokley.