JEFFERSON CITY — Having repeatedly rejected a Medicaid expansion, Missouri's Republican-led Legislature now plans to study — and study, and study — whether to revamp the health care program for the poor before it convenes again in 2014.
House Speaker Tim Jones created two new panels Thursday to examine a potential "Medicaid transformation." One group will pair citizens with legislators to gather testimony and research about potential Medicaid changes. That panel will then turn its work over to a newly created House interim committee, which could draft a proposal for the next legislative session.
The Senate already has created its own interim committee to study potential Medicaid changes. And a bill pending before Gov. Jay Nixon would authorize the appointment of a fourth Medicaid committee comprised of House and Senate members.
Medicaid is "one of the largest most complex issues that we confront every year in state government," said Jones, R-Eureka. "I think it's wise to have more eyes and hands working on the issue, and more diverse interests across the state rather than less."
Missouri's Medicaid program covered more than 873,000 people as of May.
During the legislative session that ended last month, Republican House and Senate members repeatedly defeated Democratic attempts to expand Medicaid eligibility for low-income working adults under the terms of President Barack Obama's 2010 health care law, the Affordable Care Act.
Supporters of an expanded Medicaid system said the new committees provide renewed hope that they might still prevail.
"We look at it as a very welcome development — a sign that the legislators are willing to look at some options here," said Andrea Routh, the executive director of the Missouri Health Advocacy Alliance.
Nixon spokesman Scott Holste said the Democratic governor was "heartened by the ongoing discussion on reforming and strengthening Medicaid in Missouri."
Nixon had backed a plan that would have enlarged next year's Medicaid rolls by an estimated 260,000 adults earning up to 138 percent of the poverty level — about $15,800 for an individual or $32,500 for a family of four. The federal government would have paid the full cost of more than $900 million during the state budget year that begins July 1. Eventually, the plan was projected to cover about 300,000 adults at an annual cost of about $2.3 billion, of which the federal government would pay 90 percent.
Republican lawmakers said they doubted the federal government would follow through on its long-range funding pledge. They also expressed concerns about expanding a social welfare program that they contend does not currently work well.
A GOP plan endorsed by a House committee earlier this year would have expanded Medicaid eligibility by a lesser amount than what the Affordable Care Act called for, while remaking the program to more closely resemble private-sector insurance. But that legislation never came to a House vote or attracted much interest in the Senate.
State Rep. Jay Barnes, R-Jefferson City, who sponsored this year's bill, will lead the House Interim Committee on Medicaid Transformation. The Citizens and Legislators Working Group on Medicaid Eligibility and Reform will be led by state Rep. Noel Torpey, R-Independence.
States have the option of expanding Medicaid eligibility under enhanced federal payment rates, because the U.S. Supreme Court ruled last year that states could not be compelled to enact the expansion.
Barnes said the new committees will start with no preconceived conclusions about whether Medicaid should be expanded to the levels sought under the Affordable Care Act.
But Jones ruled out one possibility. He said the legislature will not embrace a straight Medicaid expansion that is not accompanied by significant changes to the program.
"We see — and I believe Missourians see — expansion without reform as a massive misuse of taxpayer dollars on a program that provides inferior access to health care and poor health outcomes," Jones said.
He added: "If we dump hundreds of thousands of additional uninsured people into that system and give them a magical plastic card and simply say, 'Well now you have free health care,' we will further drive an already broken system into a bankrupt state."