In 2008, when Jay Nixon ran for Missouri governor, he told voters that expanding Medicaid to more poor Missourians was the right thing to do. That helped him win the job.
During the most recent legislative session, the Democratic governor fought cuts to medical insurance for blind Missourians because, again, he said it was the right thing to do.
So now, in light of the Supreme Court's decision maintaining the legality of the Patient Protection and Affordable Care Act, it's time for the governor to do another right thing. He must boldly challenge skeptical and stubborn Republicans who have no interest in fulfilling the promise of the ACA by expanding Medicaid coverage in the state to working adults who make barely more than $14,000 a year.
Like Illinois Gov. Pat Quinn, also a Democrat, Mr. Nixon should accelerate his state's plans to implement a law that will improve the health of its citizens and inject billions of new dollars into the economy.
Mr. Nixon should call a special session concurrent with the September veto session and tell lawmakers to design a health care exchange and adopt the expanded Medicaid programs called for in the ACA. The Supreme Court decision Thursday said states could opt out, but they'd be crazy to do so.
Republicans will beat their chests and talk about standing against federal intrusion. They did so in 2009 with $783 million in federal stimulus dollars at stake. In the end, they came to their senses.
During the ACA debate, Mr. Nixon ran away from questions about it as though his hair were on fire. He was absent during the legislative debate over the last two years as Republican lawmakers refused to design a state insurance exchange through which Missourians could shop for private insurance from a menu of providers. That move risks the state's beloved sovereignty, making it more likely that the long arm of the federal government will design the program instead.
Just last Monday, when most political observers were betting that the ACA would be overturned, Mr. Nixon said that he was opposed to the individual mandate.
Bad move. Worse timing.
Mr. Nixon can recover by summoning legislators to perform the two key roles given them by ACA: Designing the insurance exchange and deciding whether to inject Missouri's economy with billions of federal dollars over the next few years.
That money will not flow to our doctors, hospitals, insurance providers, nurses and medical schools unless lawmakers expand Medicaid to poor adults. The feds will pay for the first three years. After that, the state gets 10 percent of the tab — $99 million in 2017. Doing nothing will cost more, and not just in moral failure.
Missouri hospitals know this. When Republicans cut Medicaid in 2005, poor people still had access to health care, but it was through the emergency room. That care is significantly more expensive than the preventive care that is the hallmark of the ACA, and those costs have been borne by those of us with insurance.
Beyond that, the federal money that will pour into the state — $8 billion in Missouri; $19 billion in Illinois — will be an economic boon. Lawmakers would be foolish to turn it away.
This is what governors are supposed to do: Set the agenda.
Let skittish, misinformed Republican lawmakers debate whether or not poor people deserve health care. Mr. Nixon's job is to demand it.
Copyright St. Louis Post-Dispatch. Reprinted with permission. Questions? Contact Opinion editor Elizabeth Conner.