Missouri Republicans don’t appear enthusiastic as Gov. Jay Nixon champions health care for the poor

12/31/2013 3:03 PM

01/01/2014 5:17 PM

Missouri Gov. Jay Nixon gave a New Year’s pep talk on expanding Medicaid eligibility on Tuesday. But is he preaching to the choir?

As the Democratic governor noted, more than 4 million Americans will wake up tomorrow, New Year’s Day, and have health insurance for perhaps the first time. They are the people fortunate enough to live in states that have expanded their Medicaid eligibility limits.

Expansion is sort of a dirty word in Jefferson City, so Nixon, when he addressed used the more politically correct lingo, saying that the states are “reforming and improving their health care systems.” But no matter. The point is that, because of resistance and inertia on the part of the Missouri General Assembly, nearly 200,000 low-income adults fall into a coverage gap.

They make too little in income to go into the federally run insurance marketplace. But they make too much to qualify for Medicaid in Missouri, which helps parents with dependent children only if they make 28 percent or less than the federal poverty level. Childless adults are ineligible at any income.

Nixon described this group quite eloquently. “They’re factory workers and house cleaners, mechanics and truck drivers, moms and dads. These folks work tough, low-paying jobs that don’t offer health benefits, and they can’t afford a doctor’s bill.”

For all of the fulminating that goes on in the legislature about the evils of Obamacare and the perils of becoming dependent on more federal money, I’ve never heard a lawmaker explain how somebody making $18,000 a year or so is supposed to be able to purchase a health insurance policy.

In hearings earlier this year, legislators heard an earful from people who want to see Medicaid expanded. Those ranks included patients, business groups, hospitals and social service workers — just about everybody who grasps that it’s good policy all around for people to be able to see a doctor without draining their savings or leaving clinics and hospitals to eat the bill. Opponents of Medicaid expansion were few in number, and mainly came from tea party groups.

Also, as Nixon noted, the taxes that Missourians pay to the federal government will be used to expand Medicaid in the 25 states that were smart enough to authorize it.

The governor called upon the legislature to expand Medicaid this session. And it should, if for no other reason than the cost will be paid in full.

The Affordable Care Act requires the federal government to pick up 100 percent of the cost of the expansion for the next two years. By not moving more quickly, Missouri has already passed up on one year of a full reimbursement. When the law is fully phased in, the state will pick up 10 percent.

With just a few exceptions, though, Republicans who control the state legislature show no signs of rallying around a Medicaid “transformation” this session. Some GOP members of the Senate hate Obamacare enough to filibuster any embrace of it. The House at least has some Republicans who are interested in doing something, led by Rep. Jay Barnes of Jefferson City.

But chances are little to nothing will happen with Medicaid before March 25. That’s the deadline for filing to run in the August primary election for state legislative seats. Such is Missouri’s political climate that a Republican legislator who chooses to be sensible and compassionate about health care for poor people must fear a challenge from the right.

Still, if Nixon has political aspirations beyond finishing his second term as governor, his credibility in Democratic circles can only be enhanced by continuing as a vocal champion of Medicaid expansion.

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