Republicans win elections when they are accurately viewed as the reformers of broken government institutions. It is no surprise — Missourians are giving more to government via taxation and regulation than at any point in history, and yet most of these burdened taxpayers would have a hard time saying they are getting more from government than ever before.
When I arrived in Jefferson City in 2017, it did not take me long to realize the significant disconnect between the inputs to a state government that, objectively in terms of dollars, is bigger than ever and the efficiency of state programs that might be at their worst.
Indeed, one of the biggest and most broken programs is our Medicaid program, which has recently been found by independent authorities to be wasting more than a billion dollars per year. That is “billions” — with a “B.”
Each year we spend tens, if not hundreds, of millions more on Medicaid without any appreciable improvement on health outcomes. As a result, Missouri spends more taxpayer dollars per recipient than many other states but actually has worse health outcomes in many instances. Is it any wonder that faith and trust in government is under assault by the public now more than ever?
All the talk of funding any expansion of such a broken program is premature. Medicaid has been crying out for reform for a generation, but in this term-limited world, the can always gets kicked down the road. This must stop, and this year may offer a unique opportunity to pass critical reforms if we hope to have any Medicaid program 10 years from, much less a funded expansion of the program six months from now. If Republicans fund an expanded Medicaid before reform, they will risk losing their brand as reformers of wasteful government and their place as the economic conservative leaders Ronald Reagan championed almost a generation ago. But reforms are not just a political slogan — they save real money and improve the health of Missourians. Republicans have a choice: embrace our party principles of reformed, limited, and more efficient government, or join our Democratic friends in out-of-control, unaccountable, wasteful spending on massive Missouri government.
So, what do reforms look like? Well, I’ve already pre-filed multiple bills that would save Missouri taxpayers millions in Medicaid spending now and into the future.
The first reform is SB 895, which I filed last year. This is common sense legislation that prohibits the state from using our Medicaid program to fund health care for out-of-state residents. Because of our past failures to reform Medicaid, you have residents from other states visiting Missouri hospitals and providers knowing that Missouri taxpayers will pick up that bill. Anyone who is a resident of Missouri or not employed or influenced by the Missouri Hospital Association should support this legislation. If you don’t believe that, try explaining to a constituent why doubling the reimbursement for Illinois residents is good for them. When did it become OK to incentivize hospitals to care for the patients of other states above Missourians?
Additionally, I am sponsoring legislation that would require our Medicaid program to reimburse providers for outpatient services based on an actuarially sound fee that more closely tracks that cost of the medical service. Our current program pays reimbursements based on a percentage of invoices … without a cap or standard from which to judge what is reasonable. Any percentage of infinity is a lot, and in many cases, it causes Missouri to pay more for less service. The effect of this policy is that we pay hospitals and doctors more than even Medicare reimburses for these procedures and far more than the service costs. Once again: The status quo leads to taxpayers paying out more money for services, without any regard to a health outcome. I continue to hope that our new Medicaid leadership team will implement these changes without legislation. But we have waited two years for this change already — it is time for the legislature to act.
Other states, including Iowa, Indiana, and Nebraska, have set up this type of Medicaid outpatient fee schedule with good fiscal and health success. The conservative Missouri Legislature should follow suit and implement these money saving reforms in Missouri. Failing to do so, puts education and public safety programs at risk of having to be cut in order to balance the budget.
This is just the beginning of reforming our broken Medicaid program. I look forward to reviewing and helping any lawmaker that is serious about reforming our Medicaid program, so that it actually focuses on successful outcomes and saving taxpayers money. I’m under no illusion that Missouri’s Medicaid program will be run like a business overnight, but the time to reform this bloated, inefficient, ineffective program is now.
Bill Eigel is a Republican state senator who represents SD 23.