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Missouri lawmakers looking to other states for Medicaid compromise


JEFFERSON CITY, Mo. — The Republican majority has said it time and time again in the Missouri Capitol: the people do not want Medicaid expansion. Conservative lawmakers in both chambers have expressed trepidation or flat-out opposition to expanding what they call a broken, bloated, federal program.

House Speaker Tim Jones, R-Eureka, has repeatedly said that the people of Missouri rejected Obamacare. He says they did it when they blocked the state from setting up its own healthcare exchanges. He says they did it when they, by ballot measure, rejected the individual mandate.

“I’m not going to put a billion-dollar Band-Aid on a broken system,” Jones has said since the issue landed firmly in his lap last January, when Democratic Gov. Jay Nixon called for the expansion of Medicaid — a provision of the Affordable Care Act — as both the smart business decision, and a moral imperative, in his State of the State address.

Rep. Jay Barnes, R-Jefferson City
Rep. Jay Barnes, R-Jefferson City

Since the end of the legislative session, lawmakers have been quietly exploring the options available for the state.

The Senate and House both convened interim committees on Medicaid “transformation” and a special commission of lawmakers, experts and citizens was called by the House to travel the state during the summer and gather testimony.

But as states across the country weight the complex task of expansion — a task the Supreme Court ruled as optional — at least one state, whose political makeup is not unlike Missouri’s, may have found a compromise.

Later this week, the House interim committee on Medicaid Expansion, chaired by Rep. Jay Barnes, R-Jefferson City, will be discussing a plan based on the compromise legislation passed earlier this year in Arkansas. There, a Republican legislature and a Democratic governor compromised, bringing coverage to citizens in the state earning 138 percent of the federal poverty level while incorporating private insurance coverage.

“This is just an example of what one state is doing,” Barnes says. “It’s an example of one state where Republicans have a lot of say in what happens that have moved forward with a plan, it’s no more or less than that, one example.”

Barnes posted a piece of model legislation on his website last week that placed what is now being called the Arkansas Model into state statute.

At its core, the plan would expand coverage to the level demanded by House Democrats, but would allow the newly eligible individuals to shop for private insurance through the healthcare exchanges established by the ACA right alongside their Medicaid option. In other words, newly eligible citizens could compare their Medicaid plans to private insurance plans and choose their own coverage.

Barnes says it is only one of several models the committee likely will be discussing, and that it is not his intention to support the Arkansas Model in Thursday’s hearing over any other plan.

Jen Bersdale, executive director of Missouri Healthcare for All
Jen Bersdale, executive director of Missouri Healthcare for All

“You’re not going to hear me say ‘this is what Missouri should do,’” he adds. “What I want is some kind of consensus on this committee on Medicaid transformation, and that will depend on what members of both parties have to say.”

In what some are touting as a grand compromise, the plan also includes some stopgaps that the Republican majority has insisted on. For example, the legislation has a mechanism ending the entire program should the federal government fail to meet its financial obligation in matching state funds.

It also includes provisions stating that the new program is “not an entitlement program,” and “not a perpetual federal or state right or guaranteed entitlement.”

Jen Bersdale, Executive Director of Missouri Health Care for All, says many Medicaid expansion supporters, including her organization, were more concerned with raising eligibility to 138 percent of the federal poverty level than making sure Medicaid was providing the coverage.

“We want to look at the coverage for these private insurance and see, okay, is it going to give people the access to the care they deserve,” Bersdale says. “We’re open to what that might look like, but if we can have quality affordable coverage for the most vulnerable Missourians, then we’re very open to discussing what that could look like.”