WHAT OTHERS SAY: Time for Missouri Republicans to follow Rick Scott's lead

Friday, February 22, 2013 | 11:39 a.m. CST

One name haunts Missouri Republicans in the state Capitol today: Rick Scott.

Yes, that Rick Scott, the governor of Florida and tea party favorite who on Wednesday became the latest Republican governor to embrace the proposed Medicaid expansion that is a key element of the Affordable Care Act. It would bring health coverage to millions of American workers who aren’t covered by their employers and are too poor to get insurance on their own.

Rick Scott embraced Obama's health care policy? Yes, we can.

The same Rick Scott who graduated from the University of Missouri-Kansas City and made a fortune in the health care industry (oh, irony). The lean firebrand who spent $78 million of his own money on his election in 2010 and became one of the first state governors to sue to stop the health care policy. The same governor who months ago said there was no way Florida would embrace Medicaid expansion.

That Rick Scott.

He now joins Arizona Gov. Jan Brewer, Ohio Gov. John Kasich and a host of other Republican governors from Nevada, New Mexico, Michigan and other states who are embracing the Medicaid expansion as the right public policy for their states to pursue.

When Scott announced his about-face Wednesday, he used words that could have come right out of the state of the state speech of Missouri Gov. Jay Nixon. Nixon, a Democrat, also was late to the Medicaid expansion game, but is urging Missouri lawmakers to accept billions of dollars in federal health care spending to reduce the state’s number of uninsured.

“While the federal government is committed to paying 100 percent of the cost, I cannot in good conscience deny Floridians that needed access to health care,” Scott said at a news conference. “We will support a three-year expansion of the Medicaid program under the new health care law as long as the federal government meets their commitment to pay 100 percent of the cost during that time.”

That same argument should win over the Missouri legislature.

This week, Rep. Jake Hummel, D-St. Louis, filed House Bill 627, which would, as called for by the federal government, expand the state’s Medicaid eligibility to those making up to 138 percent of the federal poverty level.

Many Republicans, ignoring the fact that the federal government will pick up all the cost for the first three years and inject literally billions of dollars into the state’s health-care economy, declared the bill dead on arrival.

They boxed themselves in to a corner, no matter the Main Street reality.

When the entire business and health care community in Missouri is united behind the Medicaid expansion, because it will be good for the economy, because it will create thousands of jobs, because the federal government bears nearly all the cost, because the alternative is economic catastrophe, because it is simply morally correct, eventually lawmakers are going to do the right thing.

They will be unable to go home and face angry constituents who find out that their tax dollars are paying for health care in New York and California, while their rural hospitals slash staff and threaten closure.

They will be unable to fulfill their goals of seeking higher office when all the deep-pocketed business groups supporting Medicaid expansion — including many conservative ones — close their wallets.

They will pass Medicaid expansion or they will lose. The economy will lose. Poor people will lose. Doctors will lose. Hospitals will lose. Insurance companies will lose. Missouri will lose.

So, as unpalatable as it is for some politicians to pull a complete about-face as Scott did in Florida, it’s the gutsy thing to do.

We hope and believe that there are enough Missouri Republicans in the Capitol with such courage that one way or another, the Medicaid expansion bill will become law.

Speaker of the House Tim Jones, a Eureka Republican, has chosen his words on the issue very carefully, blasting the federal health care policy, while suggesting that perhaps the state’s Medicaid program needs an overhaul. We don’t agree with Jones on much, but he has been smart to keep the door open on this very important issue.

State Rep. Jay Barnes, R-Jefferson City, is working on such an overhaul, and while he can’t bring himself to mouth the word “expansion,” he’s a smart man, and he’s reaching out to a wide range of constituencies in trying to forge a bill that can pass the legislature.

Republicans are right that there is room for improvement in Missouri’s existing Medicaid program. It’s a wasteful, messy system. It makes no sense, for instance, that poor people in St. Louis, Kansas City and Columbia are on a managed care system while rural Medicaid patients aren’t. The system has different rules for the blind, disabled and nursing home residents than it does for other recipients.

It pays different rates depending on the service. Over the years, various powerful health care interests have carved out special deals that make no sense in a new, streamlined Medicaid system.

There is room for reform. There is an opportunity now for both conservatives and liberals to make changes to a system that is eating up an increasingly large portion of the state’s budget.

But those changes can happen only if the Missouri legislature changes, too. It must accept the expanded coverage requirements that guarantee that the federal government picks up the entire cost for the next three years. That’s the massive cudgel that could bring disparate health-care interests to the table to improve the state’s Medicaid system.

The clock is ticking on the Missouri legislative session. It’s time to get serious and follow Scott’s lead. Like Florida, Missouri can also file a federal waiver asking for permission to devise a new system. It can include a level of managed care privatization in the new model, because for many Medicaid recipients that’s already the norm. Lawmakers can re-name the plan “The Ronald Reagan Memorial Health Care Plan that is Definitely Not Obamacare.” Whatever.

Just take the money. Don’t bankrupt the state’s economy over semantics.

Copyright St. Louis Post-Dispatch. Reprinted with permission.

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