State legislators say Medicaid expansion ‘unlikely’ in next session

Wednesday, October 23, 2013 | 6:54 p.m. CDT

MOBERLY — Two state lawmakers serving on committees examining Medicaid reform options for the state legislature predicted Tuesday night the General Assembly will not pass expansion legislation in the upcoming session.

“I will stand and filibuster expansion of Medicaid until I can’t stand any longer,” said Sen. Rob Schaaf, R-St. Joseph. “And I know other senators who would do the same.”

Sen. Rob Schaaf's Plan

Sen. Rob Schaaf, who has been a family physician in northwest Missouri for nearly 30 years, told a crowd in Moberly his plan for improving health care:

1. Make insurance premiums universally deductible, regardless of where the plan comes from.

2. Provide catastrophic coverage, but not coverage of every cholesterol test or doctor's visit.

3. Put transparency into the health care market by making prices more available to patients.

4. End "roadblocks to competition" like the Certificate of Need Commission that approves of hospitals.

5. Tort reform at the national level that protects doctors from lawsuits and reduced the costs of defensive medicine.

6. Campaign finance reform that ends "the rent-seeking behavior" of special interests.

Rep. Noel Torpey, R-Independence, and the vice-chair of the House Interim Committee on Medicaid Transformation, said though a bill would likely be presented to the House, he also thought it faced obstacles.

“With term limits and in an election year, on the House side, I think it’s highly unlikely that we expand Medicaid,” Torpey said. He added that he had heard from senators who, like Schaaf, “don’t want any part of Medicaid expansion.”

Schaaf and Torpey addressed an audience of more than 35 people, who gathered Tuesday night at Nelly’s restaurant in southern Moberly for a country-style buffet dinner. The Randolph County Pachyderms Club hosted the event.

Both legislators serve on committees that have held meetings this fall to hear testimony on the Medicaid system. While most witnesses have voiced support for Medicaid expansion, many of the legislators have remained quiet during the hearings, listening attentively.

Torpey said he was still open to the possibility of expansion, as long as the right reforms were made. He said he wanted to see reforms that make eligible recipients “put skin in the game."

He pointed to states such as Iowa and Arkansas that have developed Medicaid systems that increase the number of eligible citizens and help subsidize private plans for a portion of the new Medicaid recipients.

The new U.S. health care law allows states to expand Medicaid eligible recipients to 138 percent of the federal poverty line — about $32,000 for a family of four. Expanded coverage would be fully funded by the federal government until 2016, when the state begins to gradually pick up a share of the costs. Beginning in 2020, the federal government would pay 90 percent of expanded Medicaid costs, and the state would shoulder 10 percent.

The Missouri General Assembly debated but did not pass expansion legislation last session. Missouri is among 25 states that have not moved forward with Medicaid expansion, according to a Tuesday report from the Kaiser Family Foundation.

Nationwide, 4.8 million uninsured adults may fall into a “coverage gap” of earning too much to qualify for Medicaid but not enough to qualify for tax credits through new federal exchanges, according to the report. As many as 200,000 Missouri residents fall into the "coverage gap."

When Schaaf asked the crowd who was in favor of expansion, Diane Noah of Moberly was alone in raising her hand.

“I don’t want to give (people) everything when they are able-bodied, but anyone in this room could be on Medicaid a year from now,” she told the crowd. “I’ve seen it happen to very prominent people — life happens.”

Randolph County Clerk Will Ellis said the county usually sees premiums for county employees’ health insurance increase by about 5 percent each year, but he expects larger increases this year and attributes them to the health care law. The county provides United HealthCare coverage to its 90 employees. 

Ellis said Randolph County officials expect the county's share of premium for its employees to increase by more than 14 percent for next year because of new fees under the health care law, including more than 7 percent for a transitional reinsurance fee and 4 percent for an out of pocket maximum fee.

“That’s $70,000 the county will have to pay that is hasn’t paid before,” Ellis said.

Supervising editor is Gary Castor.

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