Gov. Jay Nixon embarked on a statewide tour Thursday to publicly support the expansion of Medicaid, but local GOP representatives and senators are less enthusiastic.
A Supreme Court ruling puts the onus on individual states to decide whether they'll accept the federal funds to expand the offering to more individuals (those who earn up to 138 percent of the federal poverty level), and then take over partial payments in three years' time.
"My consistent position on expanding Medicaid has been to carefully study the options and then determine what is the best fit for Missouri," Mr. Nixon said in a news release Thursday. "That is why the budget I plan to submit to the Legislature for fiscal year 2014 will include federal funding to provide health care for an estimated 300,000 Missourians -- men, women and children -- who currently have no health insurance. It's the smart thing to do, and it's the right thing to do."
State Sen. Dr. Rob Schaaf, R-St. Joseph, said it's not going to happen because the state can't afford it.
"It's kind of like if you were to buy a house or a new car and there were no payments for three years," he said, "but after that you would have to pay for it forever. You might not want to do that."
Further, despite Mr. Nixon throwing his support behind the expansion, Dr. Schaaf said the governor has no authority without approval of the Legislature, which is overwhelmingly Republican and not likely to pass such legislation.
"The thing is," Dr. Schaaf said, "I'm a little disappointed that the governor didn't come and work with the Legislature prior to taking his position."
State Rep. Pat Conway, D-St. Joseph, said the question is, "can we forgo the amount of money Missouri will be eligible for?"
"The governor is at least heading in that direction, where we can accommodate those cuts we've had in Medicaid and sustain it," he said.
Mr. Conway said a majority of Democrats support Mr. Nixon's endeavor and he believes the issue will take up considerable time when the Legislature convenes in January. But details on how the state proceeds likely will be hammered out by the House speaker's office, Senate leadership and the governor's office.
"We'll have to see if we can get to a point where we can draw up our own rules and regulations of the compact. Then we're going to be in control of our own destiny," he said.
About $1.1 billion is funneled to higher education each year. State Rep. Delus Johnson said the only way to pay for the expenses accrued through the Medicaid expansion could be to dip into those higher education funds.
The exact cost of the expansion varies, depending on the source, but Mr. Johnson said one estimate has it costing the state around $99 million in 2017, $149 million in 2018 and $197 million in 2019.
"I think it's extremely scary when you look at it from the state budget perspective," he said.
But there could be a silver lining. Citing a University of Missouri report, Mr. Nixon said expanding the health care coverage to 300,000 more Missourians would create around 24,000 jobs in the state in 2014.
According to the report, "The Economic Impacts of Medicaid Expansion on Missouri," the labor income is expected to increase by $7 billion between 2014 and 2020. In that time, the federal government would contribute $8.2 billion, which is about 96 percent of the expansion cost. The state's contribution would be around $332 million.
The expansion is expected, according to the report, to increase state and local tax revenues by $856 million between 2014 and 2020.
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