*Correction: A bond issue endorsed by Sen. Kurt Schaefer and Rep. Chris Kelly could fund new buildings for the engineering school at MU.
COLUMBIA – With more than 200 bills and resolutions already filed in the Missouri House and Senate, the 97th General Assembly will have considerable fodder for discussion beginning Wednesday when the session opens.
A list of key topics for the upcoming session have emerged, among them Medicaid expansion, tax credit reform, bond issues for transportation and capital improvement projects and medical malpractice caps.
The General Assembly must decide this session whether to expand Medicaid as a provision of the Affordable Care Act, but fundamentally different views on the potential consequences divide the lawmakers along partisan lines.
Approximately 161,000 Missourians stand to get coverage under Medicaid expansion, now optional for states under the health care law. Those who could be eligible are in limbo, as is a pool of $8.2 billion in federal funds that would pay for most of the expansion for the first seven years.
To receive the $8.2 billion, the legislature must agree to raise eligibility limits to cover those earning up to 138 percent of the Federal Poverty Level. It would cost the state $333 million over the next seven years to fund the provision.
Republicans believe the expansion will saddle Missouri with bills it won't be able to pay, while Democrats – including Gov. Jay Nixon and legislators who represent Columbia – see it as an opportunity to get enormous returns for a modest investment.
"We will be making a pretty loud statement that this state is not serious about succeeding in the 21st century" if Medicaid isn't expanded, said Rep. Stephen Webber, D-Columbia.
House and Senate Republicans have declared equally strong opposition to expansion on grounds that Missouri will be unable to afford it in the long run.
"The governor hasn't explained how (expansion) is going to be paid for," said House Speaker Tim Jones, R-Eureka.
A study by the MU School of Medicine suggests that jobs created through the infusion of federal money would create enough tax revenue to offset the costs of expansion. Republicans disagree with those findings, saying it made unfounded assumptions in projecting a jobs gain of 24,000.
Jones and Sen. Kurt Schaefer, R-Columbia, both predicted that money would be diverted from education if Medicaid expansion is approved and funding falls short.
Rep-elect Caleb Rowden, R-Columbia, said he hasn't made up his mind about Medicaid expansion, but if it means cuts to education – he won't vote for it.
Tax credit reform
Hundreds of millions of dollars went to Missouri businesses and residents through tax credit programs in 2012. The governor and some lawmakers want to see that money redirected to the state treasury.
Significant changes to tax credit programs – which Nixon has been working toward since 2010 – have failed to pass the General Assembly in the past few years. Nixon's effort has been joined by lawmakers from both sides of the aisle, but some caution that cutting too much from programs that have benefited Missouri would obstruct economic development.
Tax credit programs give businesses and residents breaks for certain kinds of projects. The two biggest channels for credits are the Historic Preservation and Low Income Housing tax credit programs. Tax credit redemptions took 7 percent – $629 million – of Missouri's expenditures last year.
Some legislators have promised to try to scale back tax credit programs this session, and a handful of bills to do so have been pre-filed in the Senate.
A bill pre-filed by Sen. John Lamping, R-St.Louis, would cap tax credits in the two biggest programs, while a bill pre-filed by Sen. Brad Lager, R-Savannah, would eliminate some programs and also cap the largest programs.
Rowden and Rep-elect John Wright, D-Rocheport, believe money directed to tax credits should go to education instead.
"In my mind that's the safest investment because it's investing in the people of tomorrow," Rowden said.
Wright, meanwhile, said budget constraints are strapping Missouri schools; he said a school in his district has cut back to four-day weeks to manage the limitations.
Despite support for tax credit reform from members of both parties, some legislators urge caution.
Schaefer and Jones both pointed to the benefits tax credit programs have brought Missouri, including revitalization of blighted cities. Schaefer said some of Columbia's proudest cultural achievements, such as Ragtag Cinema and the North Village Arts District would not have been possible without tax credit programs.
Rowden said he expects resistance to big changes in tax credit programs.
"If you cut somebody's tax credit program, they're not gonna like it," he said. "Once you start giving away that money, it's hard to take it back."
With historically low interest rates, state legislators say they want to pass at least one bond issue to invest in Missouri's infrastructure.
A pre-filed Senate bill – backed by both Schaefer and Rep. Chris Kelly, D-Columbia – would ask voters to put almost $1 billion into higher education buildings, state parks and state buildings. Jones has proposed another bond issue to repair Missouri's highways.
The bond issue endorsed by Schaefer and Kelly could fund new buildings for the engineering school* at MU, expand UMKC's medical facilities, repair the collapsing sewage systems in state parks and improve antiquated mental health facilities.
The Missouri Department of Transportation, meanwhile, has warned that Interstate 70 warrants serious attention and puts the cost at $2 billion to $4 billion for needed repairs.
Webber said that he is doubtful a bond issue to fund reconstruction of I-70 would pass because of the amount of money involved.
"When you look at the higher ed budget, close to a billion dollars is a huge chunk," he said. "When you look at the cost of Missouri's highways, it just isn't as much."
Medical malpractice limits
In 2012 the Missouri Supreme Court overturned a 2005 law that set the limit on damages — primarily pain and suffering — at $350,000 in lawsuits alleging that health care providers caused injury or death.
The Supreme Court struck down the law on grounds that it was an unconstitutional encroachment on the rights of juries.
Rep. Bill White, R-Joplin, has filed a resolution for a constitutional amendment which, if passed by Missouri voters, would put the $350,000 cap into the state constitution.
"If you change the constitution, the Supreme Court cannot make what I kind of think is an activist interpretation," White said.
Jones said he also wants to reinstate the cap, either as a change to state law or the constitution. The Associated Press has reported that the governor is not opposed to caps.
Both White and Jones said an absence of caps brings uncertainty to medical professionals, potentially drawing them to neighboring states where caps do exist, particularly Kansas.
The Kansas Supreme Court in 2012 upheld a $250,000 cap on medical malpractice awards.
"If you're going to be a family practice doctor, why are you going to practice in Missouri? There's total uncertainty in the court system for what can happen in a judgment," White said.
Rowden agreed that caps need to be reinstated, predicting it would be one of the first things the House addresses this session. Caps are necessary to keep medical malpractice insurance low and prevent health professionals from choosing states with caps instead of Missouri to start their practices, he said.
Webber, however, said juries should retain the power to determine damages in medical malpractice suits.
"I trust the people of Missouri to decide what's fair and what's just more than I trust politicians," he said.