The Missouri Solution: Market-Based Medicaid Transformation

No doubt you have heard in the news that Governor Nixon met with Republicans this week to promote his ideas for Medicaid and to intimate that he supports our efforts of true, positive, Medicaid transformation in Missouri.  The Supreme Court decision from last summer makes Medicaid expansion optional for the states. While he may promote flat out expansion at any cost, he was willing to consider support for a proposed plan for reform from House Republicans. We also agree that it should be Missourians, not the federal government, who make these pivotal decisions for our state.

The conservatively led Missouri House is committed to finding the best solution for Missouri. We will not jeopardize the best health outcomes for our neediest citizens nor will we risk the financial stability of our state by expanding a broken, unsustainable system to include 300,000 more people. We must fix Medicaid so that it provides access to quality health care for our most vulnerable citizens at a reasonable cost to taxpayers.
Medicaid has proven itself inefficient, and many recipients receive lower quality care than individuals with private insurance or even those with no insurance at all. Many doctors refuse to take new Medicaid patients because of low reimbursement rates. And because the current system lacks competition, there is no incentive to improve care or control costs.

The failures of the current system make it imperative that we enact actual, meaningful reforms rather than slap a billion-dollar Band-Aid on a broken system. If we are going to do what is best for Missourians, we must transform our Medicaid system so that it provides high quality care to those who need it most. This means taking a commonsense, conservative approach and transforming our system into a good investment that results in healthy, productive citizens.

As we undertake the challenge of transforming Missouri’s Medicaid system, there are several key components that are critical to making the system the high-quality safety net it was meant to be:

Encourage free-market principles and competition to lower costs. Give Medicaid recipients the power to choose the plan that best fits their situation.

Incentivize preventative care.

Promote price transparency to allow recipients to shop for the most cost-effective medical solutions.

Demand less federal oversight and more flexibility. Empower our state to adapt the program to meet the needs of Missouri’s growing population and an ever-evolving health care industry.

Reaffirm Medicaid’s original purpose: to serve as a safety net for our most vulnerable citizens – seniors, children, and the disabled.

Medicaid was never meant to provide healthcare to everyone. Rather than expand the pool of recipients who receive increasingly diminished services, we need to transform Medicaid into a system that ably provides the highest quality care to those who need it most.

House Republicans are currently exploring a market-based, transformative approach to Medicaid. It incorporates many of the components listed above. The bill, HB 700, sponsored by Rep. Jay Barnes would move private insurers into a position of greater competition to provide coverage for low-income Missourians. It would empower Missourians, turning recipients into participants who actively make health care decisions and not wait until their health care needs require the emergency room. This system has the potential to vastly improve quality of care while containing costs and reaffirming Medicaid’s role as a true safety net.

HB 700 is not the final solution to the Medicaid crisis, but it is a solid starting point. From here we can work toward a sustainable Medicaid system that can continue to meet our state’s needs for years to come. We will continue to monitor the innovative solutions proposed by other states. Arkansas, for example, is pushing for a system that would enroll those newly eligible for Medicaid into the same private insurance plans available to individuals and small businesses.

Regardless of how we proceed, in the end we are dependent on whether the federal government will grant us a waiver that empowers our state to transform our Medicaid system. The White House structured Medicaid expansion as a take-it-or-leave-it ultimatum when it comes to states getting federal dollars for the program. However, as the President sees more and more states refuse to accept the money along with all rigid federal requirements, we see a greater willingness to allow state governments flexibility to transform Medicaid as they see fit.