By Johnny Kampis | Missouri Watchdog
ST. LOUIS — Missouri Republicans filed a bill Tuesday seeking to reform the state Medicaid system, a day after rejecting a Democratic bill that sought to expand the health-care program for low-income residents.
The bill by Rep. Jay Barnes, R-Jefferson City, would offer cash incentives to Medicaid patients who avoid seeing doctors for minor issues, thereby reducing the overall cost of the program for taxpayers.
Barnes’ legislation would also add some adults to Medicaid rolls by increasing eligibility to the federal poverty level, which is about $24,000 for a family of four, while removing some children whose parents earn up to three times the federal poverty level.
Currently, adults in Missouri must earn no more than 19 percent of the federal poverty level to enroll, but children of higher-earning adults can participate.
The so-called “Show-Me Transformation Act” would also let private insurers bid to offer managed care plans and require annual evaluations of families to ensure eligibility to participate in Medicaid.
Participants could choose from a co-payment or high-deductible plan. They would get electronic benefit cards pre-loaded with health-care credits. If they avoid using all of their money in a year, they’ll get some of the cash.
“They get to keep a portion of the amount of money they save the Missouri taxpayers,” Barnes said.
House Speaker Tim Jones called the bill a “commonsense conservative” proposal.
“I look at this as – at a minimum – a two-year project,” he said. “We’re just at the very beginning of it.”
Missouri’s Medicaid program now serves about 879,000 individuals. Barnes’ bill is expected to add about 180,000 more adults to the
roster while removing about 44,000 children. Republicans hope this plan will help more state residents access Medicaid while not greatly increasing costs to the state’s coffers.
The Obama administration has said that states that do not raise eligibility to 138 percent of the poverty level will not qualify for the increased federal funding so, barring a change in policy, no extra federal money will be forthcoming.
A 5-2 vote along party lines in the House Government Oversight and Accountability Committee on Monday killed House Bill 627, which would have given about 260,000 more Missourians access to Medicaid.
The GOP expressed concern about the long-term costs of the plan. Although the state doesn’t have to pay for the extra coverage up front, a match would be phased in over time, rising to 10 percent in 2020.
The Kaiser Foundation said Missouri could get $8.4 billion in federal funds in the first five years of Medicaid expansion with a $431 million investment, but Republicans are worried that Congress won’t keep its funding promise on this optional ACA provision.
“When the federal government has a $16 trillion debt and a $1 trillion deficit, I don’t think we can count on them keeping costs low for the states,” he said.
Barnes, who chairs the oversight committee, likened the Democratic plan to backing an armored truck up to Missouri’s border during the Monday hearing.
“I think we’ve seen that approach with several failed stimulus bills from the current administration,” he said. “What evidence is there that we’re going to get a different result this time in the Brinks truck economics model?”
Barnes further described that model as “where we ask the federal government to send as many Brinks trucks full of borrowed cash from China as it can possibly gather together, and dump it into Missouri’s economy.”
House Democratic Leader Jake Hummel said Missouri should participate, since other states will get the funding anyway.
“The Brinks truck is leaving Washington and heading for other states,” he said. “I would like the Brinks truck to stop in this state and create jobs in this state.”
Gov. Jay Nixon’s budget for fiscal 2014 initially called for an additional $907 million in federal Medicaid spending, as well as $46 million in savings and general revenue anticipated from the influx of Washington, D.C. health-care dollars. But Republican budget hawks removed those figures from the budget likely to be passed by the House.