Senate Medicaid panel splits over expansion; Democrats stymied

Wednesday, November 13, 2013 | 8:48 p.m. CST; updated 9:22 p.m. CST, Wednesday, November 13, 2013

JEFFERSON CITY — Three Democratic state senators walked out of a Medicaid committee work session Wednesday because Republican members refused to discuss expanding Medicaid eligibility.

The committee instead considered a slew of other recommendations.

When the Democrats returned to the meeting with a list of their own recommendations to add to the committee’s final report, the committee rejected the additional language.

The Democrats' list included acknowledging that the majority of testimony from the public supports Medicaid expansion, Medicaid expansion would save the state money, and the General Assembly should consider waiver options other states have developed.

“The bulk of the testimony was on Medicaid expansion, and here in this report — which I am appalled by — we have no recommendations for expanding Medicaid,” said Sen. Jamilah Nasheed, D-St. Louis.

Sen. Gary Romine, R-Farmington, chairman of the Senate Interim Committee on Medicaid Transformation and Reform, said that the minority members leaving was not productive and made it more difficult for them to achieve their goals.

“I was very disappointed that they left. That was hard to take,” Romine said. “I was willing to accept their coming back and trying to work with them, but it created a wedge and a difficulty to go forward with what they were presenting.”

After the committee’s three minority members left the meeting to draft their own recommendations, the Republicans on the committee went through a list of 16 reforms to the current system. Romine and the report stressed that the state needs to improve its current system before taking on thousands of new participants.

“The committee believes that before the state can consider expanding eligibility and increasing the number of participants to the program, transformation of the entire Medicaid program must occur,” according to the committee’s draft report.

The reforms included expanding groups currently covered by managed care plans statewide. Managed care plans, which currently cover some Medicaid participants in more than 50 counties along the Interstate 70 corridor, allow the state to contract with private companies responsible for developing provider networks to care for Medicaid participants. The contracts set rates based on the number of participants being covered and specific measures of health improvement.

“Managed care is the most efficient way of handling the Medicaid population,” Romine said. "They've got systems in place, they've got technology in place. ... I realize that the free market is the best way to serve."

Not all of the senators agreed that managed care plans were as effective at reducing costs as their proponents argued.

“Putting everyone on managed care gives me a bit of heartburn,” said Sen. Rob Schaaf, R-St. Joseph. “We don’t pay the providers enough now. I can't imagine we can put all of these people on managed care and provide the same service and still save money.”

Schaaf also said most of the witnesses who testified in favor of expanding managed care were representatives of managed care companies and stand to benefit financially from more responsibility.

Unlike his Democratic colleagues, Schaaf succeeded in adding a recommendation of his own to the committee's list: tort reform. Tort reform caps the amount of damages doctors can be forced to pay if sued for malpractice.

"It’s a well-known fact that defensive medicine contributes to a great percentage of the cost of health care,” Schaaf said.

Despite Romine's objection that tort reform was outside the committee's purview, the committee's other Republicans approved Schaaf's recommendation.

"Talk about a waste of time, a complete waste of time," said Sen. Paul LeVota, D-Independence. “Adding (tort reform) makes it the pet project committee.”

The Senate work session comes a week before a similar House committee plans to meet for the last time and two weeks before a meeting about Medicaid between members of both committees and Gov. Jay Nixon.

Republican members of the House have also expressed concerns with expanding the Medicaid population throughout their hearings. Chairman Rep. Jay Barnes, R-Jefferson City, presented budget projections to his colleagues that estimated the state would save more than $40 million in general revenue by 2021 if the state were to expand Medicaid.

Joseph Keaveny, D-St. Louis, said he was heartened by Barnes’ projections. “The most intriguing part of it was he challenged his colleagues (to offer alternative projections). ... To date, I haven’t seen anyone disagree with his numbers,” he said.

The three Senate Democrats were planning to meet and decide if they would develop a minority report to accompany the other recommendations, but none of them were willing to sign the report as it was discussed during the work session Wednesday.

Other recommendations in the committee's final report include:

  • Expand programs designed to manage “super utilizers” such as the Department of Mental Health homes;
  • Promote the use of technology and telehealth in the state;
  • Strengthen investigations of participant abuse;
  • Include dental services for adults and the disabled in plans; and
  • Reinvest savings into provider reimbursement rates.

Supervising editor is Gary Castor.

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