JEFFERSON CITY — Missouri's Republican-led legislature dealt a triple defeat Wednesday to a Medicaid expansion plan as Democratic Gov. Jay Nixon continued to travel the state trying to rally support for an enlarged health care program for lower-income adults.
In successive party-line votes, the Senate Appropriations Committee defeated legislation authorizing a Medicaid expansion after listening to more than two dozen witnesses in favor of it. Then the House Budget Committee defeated two amendments that would have added the Medicaid expansion to the next state budget.
The votes marked the third, fourth and fifth times within the past several weeks that Republican lawmakers have rejected the Medicaid expansion called for under President Barack Obama's health care law. But Wednesday's votes came with a bit of an exclamation mark because they occurred on the same day Nixon held news conferences in support of the expansion in the rural communities of Chillicothe and Farmington.
Since announcing his support for the Medicaid expansion after winning re-election last November, Nixon has held at least 22 news conferences around the state touting the economic and medical benefits of adding an estimated 260,000 lower-income adults to Missouri's Medicaid rolls that already include more than 880,000 people. For the first three years, the federal government would fully fund the expansion. After that, states must pick up a share that gradually increases to 10 percent of the cost.
Legislation by Sen. Paul LeVota, D-Independence, sought to implement the Medicaid expansion with a provision that would automatically halt it if the federal government failed to follow through on promised funding.
But Senate Appropriations Committee Chairman Kurt Schaefer, R-Columbia, said it wasn't politically realistic to accept the federal money, add thousands of people to the government-funded health care program and then kick them off after several years. Schaefer said he, too, wants to improve the Medicaid program. But he asked rhetorically: "Is this the right fix? Is this the right way to do it?"
LeVota said he was thankful for the public hearing but disappointed in the Republicans' quick rejection of the bill. The vote occurred immediately after the end of a public testimony period in which doctors, hospital officials, patients, business leaders and health advocates all testified for the bill. Only one person spoke against it.
"When you have the level of support for this bill that was demonstrated today, you would think the politics would go the other way at some point," LeVota said.
Last month, a Republican-led House committee defeated a Democratic-backed Medicaid expansion bill in almost the exact same fashion on the same day that a separate House appropriations committee also rejected an amendment to insert it into the budget. Republicans have expressed concerns about the long-term costs — both to the federal and state governments — and the effect on other services.
"It is still my opinion we are going to have to pillage education funding to get to the point where we can make this work," said Rep. Caleb Rowden, R-Columbia, a House Budget Committee member who voted against the Medicaid expansion Wednesday.
After Wednesday's Senate committee vote, William Fogarty, a retired physician from Webster Groves,said the outcome appeared to be "pre-programmed," but he expressed hope that Republicans would now turn their attention to alternative proposals to expand health coverage.
"If you want to exclude some more affluent people who are going to get help (under a Medicaid expansion), I would have less of a problem with that, but if you exclude the poorest people who have the most need, it's just morally offensive," Fogarty said.
Earlier Wednesday, the Missouri Hospital Association and the Missouri Chamber of Commerce and Industry released a report saying that the cost of providing care to the uninsured could nearly triple to $3.5 billion annually by 2019 if the Medicaid expansion is not enacted. It said those costs would likely be shifted to businesses and individuals with commercial insurance policies, amounting to a "hidden health care tax."
"This new report presents a stark choice: We can bring our tax dollars back to Missouri to strengthen Medicaid and reduce costs for employers and families, or we can send these dollars to other states and see these costs skyrocket," Nixon said in a written statement.