Barbara Shelly

Medicaid expansion dead in Missouri, but reform is alive and kicking

Make no mistake. There will be no Medicaid expansion in Missouri. Not this year, not as long as Republicans control both chambers of the General Assembly.

There may, however, be Medicaid reform in Missouri. And should that happen to provide insurance coverage for more low-income Missourians and bring the state closer to compliance with the federal Affordable Care Act, well, so be it.

Just don’t use the “e” word.

There are now three legislative committees set up to study Medicaid reform — one in the Senate and two in the House.

House Speaker Tim Jones announced the formation of the two committees under his direction last week with a flourish. In a 20-minute news conference, he pronounced Missouri’s Medicaid system as broken.

“I see expansion without reform as a massive misuse of taxpayer dollars on a program that provides inferior access to health care and poor outcomes,” Jones said.

Not everyone involved in Medicaid as a patient or provider would agree with the part about inferior access and poor outcomes. A well-funded Medicaid system is a straightforward and capable safety net for the poor.

There would probably be near universal agreement, though, that from a sick person’s point of view, not having any kind of insurance is more inferior and produces even poorer outcomes than being on Medicaid. And that’s the case with hundreds of thousands of low-income adults in Missouri.

Still, Republican leaders aren’t wrong to want Medicaid recipients to have some skin in the game, so to speak. Ideas batted around so far would require copays for doctor’s visits and financial incentives for people who take measures to reduce their health care costs. Republicans are also interested in shifting some new and existing Medicaid recipients into private insurance plans.

Depending on how they are carried out, none of those are bad ideas.

The makeup of the three committees gives some hope that legislative leaders are at least somewhat serious abount wanting to get something done. Jones selected Republican lawmakers Jay Barnes of Jefferson City and Noel Torpey of Independence to chair his two committees. Barnes has been working on a Medicaid “transformation” for about a year, and Torpey is also thought to want to make something happen.

(Torpey’s committee will be a fact-finding body consisting of citizens and state officials that will hold hearings around the state. It will then present its findings to Barnes’ committee.)

The Senate committee is being chaired by Gary Romine of Farmington, who is thought to be serious about getting something done.

On the down side, one of the Senate committee members is Republican Rob Schaaf of St. Joseph, an ardent opponent so far of any kind of Medicaid expansion. Whether he’ll buy into the reform concept remains to be seen.

Also, it’s pretty clear that the House and Senate aren’t talking to each other about Medicaid yet. There has been no mention of a joint study committee. If the House and Senate come up with radically different ideas about what “reform” means, then it’s going to be a struggle to get anything done.

For now, though, it’s encouraging to see a process set up to perhaps make the state and families more secure by getting more people under a health plan.

Just don’t call it expansion.