Dave Helling | Missouri governor pushes for Medicaid expansion

Dave Helling
Dave Helling

The word shot through Missouri’s medical care community last Wednesday — in a series of news conferences the next day, Gov. Jay Nixon would announce his support for expansion of the state-federal Medicaid program for the poor.

Health care providers and lobbyists were stunned. Like most Missourians, they were unaccustomed to Nixon taking

any any

controversial issue in the state, let alone something as politically difficult as a budget making it easier for the working poor to get health coverage.

Jay Nixon does many things well, but leading the parade isn’t one of them. On this, most Republicans and Democrats agree. So why would the now-lame duck governor stick his neck out on a tough issue just weeks before a veto-proof GOP majority takes control of the General Assembly?

First, he may have decided it’s a good idea. Give him that.

There are also vague rumors that Nixon has some interest in higher office — say, Clinton-Nixon 2016. Turning aside the signature accomplishment of the incumbent Democratic administration would put the kibosh on



Mostly, though, Nixon may have actually concluded he’s got an outside shot of convincing Republican state lawmakers to take the federal cash and add another 200,000 people to the state’s Medicaid rolls.

Here’s why.

Rural hospitals are already squawking about cutbacks in federal subsidies for uninsured care — money the Medicaid expansion is supposed to replace. Many Republicans represent districts whose hospitals are in jeopardy.

Additionally, there are signs the granite-like GOP opposition to all things Obamacare has started to crack. Some Republicans, for example, are asking why they should allow the federal government to set up the health insurance exchanges planned for next year. Better, they argue, for the state to set the rules.

But there’s another reason Republicans may be ready to deal with Nixon, a reason unrelated to the health issue.

Quietly last week, House Speaker Tim Jones proposed an ethics reform bill. Among his proposed reforms is a requirement that secret non-profit companies who give to political campaigns disclose their donors.

In 2010 Republicans spiked a similar proposal included in an ethics bill offered by then-Rep. Jason Kander, now Missouri’s secretary of state.

Why the change of heart? Because some Republicans got hammered this election cycle by the secret non-profits. Experience, it seems, trumps politics.

But motive isn’t important — results are. Nixon may have concluded that Republican lawmakers can still show a certain flexibility if they can be convinced expanded Medicaid would be affordable.

He started to make that case last week. He’ll need every bit of whatever political capital he might hold to push the issue over the finish line by next May.