Testimony So Far Favors Medicaid Expansion

Final meeting of Missouri House committee scheduled in St. Louis

KANSAS CITY, Mo. – A special Missouri House committee that is travelling the state for input on Medicaid reform has heard more testimony in favor than against expanding the program, according to the panel’s chairperson.

“We have heard more positive wherever we have gone,” said Rep. Noel Torpey, an Independence Republican.

The committee includes state representatives and members of the public. It is scheduled to hold the last of six hearings in St. Louis on Wednesday. The first hearing was in Independence about a month ago.

The committee is tasked with preparing a report for the House Interim Committee on Medicaid Transformation, which will then work on a proposal for consideration by the Legislature in 2014.

Torpey tweeted a few weeks ago that it was “crystal clear” Missourians favored expansion and reform of the Medicaid program.

As of Tuesday morning, Torpey said, 85 people had signed up to speak at the St. Louis meeting.

Now is the time, he said, for skeptics of expansion to voice their concerns.

“If people have a problem with something,” Topey said, “don’t wait until it is passed. Do it while the process is happening. Don’t complain about a piece of legislation when it is too late. Positive, negative, however you feel on it, make a statement now.”

A similar committee is at work in the Missouri Senate. Its second hearing is set for Wednesday in Jefferson City.

Driving the discussion is the federal Affordable Care Act.

Under the law commonly referred to as Obamacare, the federal government has pledged to pay 100 percent of a state’s Medicaid expansion costs for three years, starting in 2014. After that, states would have to contribute 10 percent. The federal government currently covers about 61 percent of Missouri Medicaid costs, which run more than $8 billion annually.

States are eligible for the higher percentage of federal aid if they extend coverage to include people earning up to 138 percent of the federal poverty, which is about $15,200 annual income for an individual and $21,300 for a family of four.

Except for certain special populations, such as pregnant women or people with disabilities, income eligibility for Missouri Medicaid currently is set at 19 percent of the federal poverty level.

Efforts to both expand and “transform” the Medicaid program were unsuccessful in this year’s session of the General Assembly.

Much of the attention going into next year’s session is on the Senate, where a few determined opponents could scuttle expansion efforts.

Two expansion foes, Republican Sens. Rob Schaaf of St. Joseph and John Lamping of Ladue, recently reiterated their view that there is broad opposition in the Senate to expanding Medicaid.
Schaaf is on the Senate interim committee that is studying the issue.

“I’ve read some of those quotes,” Torpey said. “I would not close the door (on expansion and reform) by any means.”

Medicaid expansion advocates continue to press their case to lawmakers through groups such as Missouri Health Care for All and the Missouri Medicaid Coalition.

Supporters can’t assume that testimony in favor of expansion before Torpey’s committee will translate into legislative adoption, said Jen Bersdale, executive director of Missouri Health Care for All.

She said a Senate committee last year heard testimony overwhelmingly in favor of expansion but refused to endorse a measure that would have expanded eligibility to the level specified in the Affordable Care Act.

“A preponderance of testimony is probably not going to be enough,” Bersdale said.

She said expansion supporters also are gathering constituent stories to forward to lawmakers to help make the case.

Both Bersdale and Andrea Routh, executive director of the Missouri Health Advocacy Alliance, said they thought Sen. Gary Romine, a Farmington Republican who chairs the Senate Medicaid study committee, appears open to a full range of options, including expansion.

Routh said she thought it was a positive sign that Romine seemed interested in researching other states’ reform efforts.

“Transformation is something we are all willing to look at,” she said. “But don’t forget, we also want this federal money to come into our state to provide people coverage.”

On the House side, Routh said, it appeared that Speaker Tim Jones, a Eureka Republican, was unwilling to support Medicaid expansion.

But she said she hoped that he would allow consideration of reform legislation.

But one member of Torpey’s committee, Rep. Jeremy LaFaver, a Kansas City Democrat, dismissed the process as a “dog and pony show.”

He did not see any utility in the committee gathering and summarizing all this testimony to turn it over to the next committee, which is headed by Rep. Jay Barnes, a Jefferson City Republican, who presented a detailed legislative plan this year.

The bill did not call for full expansion to draw down the federal dollars.

“Unless you can get through Rob Schaaf and John Lamping,” LaFaver said, “I have yet to see a path to expanding Medicaid.”

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