WHAT OTHERS SAY: Iowa's Medicaid waiver should push Missouri Republicans to act

Thursday, December 26, 2013 | 6:00 a.m. CST

Another of Missouri's border states, with a Republican governor no less, is a step closer to expanding Medicaid and reaping the economic benefit of billions of dollars flowing into its state.

For those pushing to bring more health care to the working poor of the Show-Me State, and the massive economic benefits an infusion of $8 billion in federal spending would bring, this is a very important development.

This month, the Washington Post reports, the federal Department of Health and Human Services told Iowa that it was prepared to approve its request for a waiver that would allow it to expand Medicaid in a way different than what is called for in the Affordable Care Act.

Instead of merely adding people making less than 138 percent of the federal poverty level to the state's Medicaid rolls — the simplest and least expensive solution — Iowa wants to do what other Republican-led states have proposed.

It wants to expand Medicaid to people making 100 percent or less of the federal poverty rate, and then offer subsidies for those between 100 percent and 138 percent of poverty to purchase private health insurance through the state insurance exchange.

Why does this matter in Missouri?

It's very similar to the Medicaid expansion proposal developed by state Rep. Jay Barnes, R-Jefferson City. Mr. Barnes understands what Gov. Jay Nixon, a Democrat, understands, what the Missouri Chamber of Commerce understands, what researchers at MU understand: Bringing $8 billion in federal investment to one of Missouri's most important business sectors isn't just the right thing to do morally, it creates jobs.

As long as the Missouri legislature flounders and fails to adjust the state's health care system to the new federal reality, our tax dollars will go elsewhere, to border states like Iowa, Arkansas, Illinois, Kentucky and Tennessee, or the 21 other states smart enough to expand Medicaid with the federal government paying the freight.

It boggles the mind that Mr. Nixon and the legislature would commit the state to giving up about $2.4 billion in taxpayer dollars to lure up to 8,000 jobs from Boeing, when by just saying yes to the infusion of $8 billion in federal dollars over just three years almost three times as many jobs will be created if you apply the same economic multipliers.

In one case, Missouri taxpayers are literally paying a company for the right to locate their jobs here, thus limiting the economic impact those eventual jobs will have.

In another case, the federal government is willing to pay Missouri to give more poor people access to quality health care services and thus create jobs in an industry that generates about $19 billion in economic activity per year in the state.

Mr. Barnes' recent analysis of his proposal shows that, if implemented, the Medicaid expansion could save money in the state's general revenue budget for the next eight years. That's five years into the time period in which the state takes over some of the cost of expansion.

Create jobs. Save the state budget. Provide health care for those who need it.

What is the Missouri legislature waiting for?

If this was called Boeingcare instead of Obamacare, the legislature would have acted long ago.

Copyright St. Louis Post-Dispatch. Reprinted with permission.

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Michael Williams December 26, 2013 | 8:10 a.m.

"...with the federal government paying the freight."

No, the federal government isn't paying the freight. I am. And, so are you...if you pay federal taxes.

It's a lie to say otherwise.

Presumably smart folks at the STL Post Dispatch know this, but can't sell their "plan" by printing the words "Taxpayers will be paying the freight". Instead, they create a fictitious, god-like federal government that has money independent of us taxpayers, a gov't possessing some sort of money-tree hidden away within the forests surrounding Washington, DC, that can "pay the freight"....We citizens simply don't have to worry about it because the ONLY money source is the federal government.

It is this kind of "word playing" that leads citizens to dependency and a sense of entitlement.

There may be good reasons to enhance Medicaid in Missouri.
But, ANYONE who tries to sell this notion using verbiage that infers our federal government's money is "free" and independent of taxpayers is going to be called an out-and-out me.

If it's worth doing, then you can sell it with verbal honesty. But, if you lie with your words, I will fight you even if you have a good idea simply because your intellectual honesty is shot. Why associate with a liar? Does a good end justify a lie?

(Report Comment)
dan elliott December 26, 2013 | 9:04 a.m.

free money ... crazy not to take it / unless you believe that the country is on the road to bankruptcy and every additional dollar it borrows puts us as in all of us closer to being beggers. some think the answer is to quit taking this free money before we owe all to the Chinese. many things can be debated, but, the benefit of borrowing money on expenses instead of investment should have been taught long ago, if our schools are actually an investment.

(Report Comment)
Ellis Smith December 26, 2013 | 9:42 a.m.

For those not initiated, which would probably include most Missourians (and therefore Missourian newspaper readers), here are some notes concerning the present situation in Iowa.

[I was born and attended public schools K-12 in Iowa, after which I exited the state to attend a marvelous - I mean it! - public technical institute in another state. I did not reside in Iowa again until September 2012, an absence of 61 years.]

We do have a Republican governor. He had been governor previously for several terms; if he decides to run for another term HE WILL HOLD THE NATIONAL RECORD FOR NUMBER OF TERMS SERVED (although his terms have been discontinuous).

He had retired from active politics and become president of a medical school, but was asked to run for governor again.

Why? Because his predecessor, a Democrat, had consistently persued policies that RAN IOWA INTO FINANCIAL BANKRUPTCY.

That predecessor is currently U. S. Secretary of Agriculture in the Obama administration.

Our Republican governor will probably run again. The state's Democratic Party admits they are having problems finding someone willing to run against him, and that registered Democrats might not vote for that person.

The governor is a Republican; the House has a Republican majority; the Senate has a Democratic majority.

How does THAT work? Is works exacty as it did in federal government when Reagan was President: lots of compromise. Nobody gets everthing they want, but everyone gets something they want.

[Contrast that with Missouri, where the sides each use the "my way or the highway" approach, including editorial writers in the Post-Dispatch and Star, and certain writers in the Missourian.]

The political situation in Iowa has been showcased in "The Economist" magazine this year as an illustration of how politically divided government CAN work effectively.

A little humor. The Iowa Governor's Mansion is an ornate 19th century ediface called Terrace Hill. The Governor's name is Terry Branstad. During the terms, past and present, when Branstad has been governor the house has been called "Terry's Hill." :)

(Report Comment)
Michael Williams December 26, 2013 | 1:12 p.m.

DanE: "...but, the benefit of borrowing money on expenses instead of investment should have been taught long ago"


The WORST investment anyone can make is used to pay current expenses.

The BEST investment is one that creates assets....a REAL hope and a future.

PS: Assets take many forms. It's unfortunate many do not recognize them. Such recognition is the difference between freedom versus servitude, happiness versus sadness, health versus illness, success versus failure, and comfort versus worry.

(Report Comment)

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