Here’s why there’s no Medicaid expansion for Missouri

05/15/2014 6:58 PM

06/03/2014 10:17 AM

Missouri had a path to Medicaid expansion this year.

The governor and the state’s leading business groups wanted it. All of the legislature’s Democrats and a growing number of Republicans supported it. Retired U.S. Sen. Kit Bond, a Republican, lobbied tirelessly for it.

Barring an end-of-session miracle before 6 p.m. Friday, however, Missouri will not expand Medicaid eligibility this year. Nearly 300,000 working adults will spend another year locked out of access to affordable health care because their income level places them in a coverage gap.

Standing in the path of Medicaid expansion are a few self-righteous men in the Missouri Senate. Three in particular have vowed to stop it at any cost.

Ladies and gentlemen, introducing:

Rob Schaaf

The Republican senator from St. Joseph is a family physician with a long-standing feud with the Missouri Hospital Association and an outspoken contempt for people in need of government help.

As a member of the House, Schaaf took the lead in blocking a proposal to expand Medicaid eligibility with a tax paid by hospitals. He memorably referred to helping low-income people afford health care as “economic slavery.”

But in 2008, Schaaf played a key role in negotiations that would have helped pay insurance premiums for thousands of low-income Missourians. That plan, championed by then-GOP Gov. Matt Blunt, fell through when Schaaf insisted on including measures that hospitals opposed.

Sen. Ryan Silvey, a Republican from Kansas City, North, who pushed fiercely to get the Senate to consider Medicaid expansion this year, adroitly pointed out on the Senate floor that Schaaf had been willing to expand access six years ago, and said the hospitals were willing to agree to some of Schaaf’s previous demands to get Medicaid expansion this year.

“I’m just not interested,” Schaaf kept saying.

Kurt Schaefer

At one time, the lawyer from Columbia might have brainstormed a creative idea for expanding Medicaid to low-income Missourians, even if, as the Senate appropriations chairman, he was concerned about the long-term expense.

But Schaefer, a Republican, is eying the 2016 attorney general’s race. Since winning re-election as a moderate two years ago, he has swung sharply to the right. His disgruntled constituents no longer matter; it’s all about GOP primary voters.

John Lamping

The senator from St. Louis County has been the most strident opponent of Medicaid expansion this year. A financial adviser, he has said that his horror at the passage of the Affordable Care Act motivated him to run for his Senate seat in 2010.

Lamping has criticized Republicans who want to expand Medicaid for being too pragmatic. “I don’t trust the federal government,” he said during one debate. “What we don’t have enough of is people who are willing to stand up and say, ‘stop.’”

During that same debate, Silvey pointed out that Lamping, like Schaaf, had actually voted to incorporate some elements of the Affordable Care Act into the state budget, such as funds to raise reimbursement rates for doctors who treat Medicaid patients.

“Well then I made a mistake,” Lamping said.

Though his district is in eastern Missouri, Lamping owns a home in Overland Park, and his children attend schools in Johnson County. Happily, he does not intend to run for re-election.

Schaaf does, however, and Schaefer has two years left in his term after this year. Any road to Medicaid expansion next year may have to run through Schaaf’s grudges and Schaefer’s ambition.

Two men standing in the way of health care for 300,000 persons. They are wrong, and we should let them know it.

Reach Barbara Shelly at 816-234-4594 or bshelly@kcstar.com. Twitter: @bshelly.

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