JEFFERSON CITY — Rallying with one of the largest crowds of the year at the Missouri Capitol, Gov. Jay Nixon urged activists Tuesday to implore reluctant Republican lawmakers to expand Medicaid coverage to hundreds of thousands of lower-income adults.
The Democratic governor headlined a nearly hour-long pep rally that his administration says drew more than 1,000 people to the Capitol — a crowd so large that some state employees were asked to park their vehicles elsewhere Tuesday to make way for the busloads of rally participants. The event featured business leaders, doctors, pastors and police officers, all lending their support to the Medicaid expansion called for under President Barack Obama's health care law.
Nixon, who has been public office for 26 years, praised the proposed Medicaid expansion as the greatest opportunity to do good for the greatest number of people in his political career.
"Let's make sure that the words we've said here are turned into action up there," said Nixon, pointing upward to the third floor of the Capitol, where the House and Senate chambers are located.
Yet Tuesday's rally may have done little to change Republican legislative leaders, who repeatedly have rejected a traditional Medicaid expansion while citing concerns about its potential long-term costs.
"In my opinion, a supermajority of Missourians, who I consider my constituents, do not want us to implement any form of Obamacare in this state," House Speaker Tim Jones, R-Eureka, told reporters as Nixon participated in the rally.
Obama's 2010 health care law envisioned a Medicaid expansion as one of the primary means of providing health coverage to those currently without insurance. A Supreme Court ruling last summer made the Medicaid expansion optional for states but left in place a powerful financial incentive. States that expand adult Medicaid coverage to 138 percent of the poverty level — about $15,800 for an individual or $32,500 for a family of four — can receive full federal funding for the first three years, starting in 2014. The federal share will be gradually scaled back to 90 percent by 2020.
Nixon says about 300,000 Missouri residents could eventually gain coverage under the Medicaid expansion — a one-third increase in the size of the current program. He also contends the influx of federal money will spur thousands of new jobs and generate more than enough tax revenue and savings to offset the additional state dollars that eventually would be spent on the program.
A Republican-led House committee has endorsed an alternative Medicaid plan that would add some adults to the rolls, though not as many as Obama's administration has said is needed to qualify for the enhanced federal funding. The GOP plan also would remake Medicaid to more closely resemble private-sector insurance.
But rally participants said it would be foolish to insist upon overhauling Medicaid while delaying the receipt of the federal money.
"Postponing Medicaid expansion until it is perfectly reformed is like leaving shipwrecked passengers treading water and sinking because somebody thinks that the rescue vessel needs some business-process improvement," said Dr. Heidi Miller, of the Family Health Care Center in St. Louis.
Miller predicted that if Missouri waits even one more year to expand Medicaid, doctors and nurses would leave to take more lucrative jobs in states that are enlarging Medicaid.
Among the arguments that Nixon has been making for a Medicaid expansion is the fact that the federal health care law cuts funding to hospitals for the cost of treating uninsured patients beginning in 2014. Without adding those uninsured patients to the Medicaid rolls, hospitals stand to lose money, Nixon has said.
Yet Obama may have partially undercut that argument last week by proposing to delay the federal funding cut to hospitals by a year. Some Republican Missouri lawmakers have cited that as an additional reason not to act this year on a Medicaid expansion.
Lisa Church, a spokeswoman for Bothwell Regional Health Center in Sedalia, stressed Tuesday that Obama's funding-cut delay is only a proposal.
"I'm afraid that it gives people a false sense of security, and this really is an urgent issue," said Church, who was near the front of the audience at the rally.
Participants held red-and-white signs that said such things as "Strengthen Medicaid Now" and wore stickers proclaiming: "Full Medicaid Expansion Now."
Pastor Ron Webb, of Mount Calvary Powerhouse Church in Poplar Bluff, began the event with a praying that legislators "would do the righteous thing, and that's to vote for Medicaid expansion. "