Finding the Right Solution for Medicaid in Missouri

Throughout this session, your Republican-led House of Representatives has stood firm against reckless proposals to drastically expand Medicaid - a system already fraught with waste, fraud, and abuse. While I am committed to providing the truly needy with access to medical care, blindly throwing money into a broken system will not solve the underlying problems that plague our healthcare system. Simply enlarging Medicaid will not lower climbing prices, improve the quality of care, or stop people from taking advantage of a program meant only for the most vulnerable in our society. Transforming Medicaid is the only way to make the system more efficient and effective, so this is the task we in the House have dedicated ourselves to.

This week, the House passed HB 986, sponsored by Representative Jay Barnes, which creates the Joint Committee on Medicaid Transformation to investigate needed reforms. This bipartisan group of Representatives and Senators will meet with organizations and citizens from around the state to explore ways to limit skyrocketing medical costs, encourage preventative care, comply with federal mandates, and help able-bodied adults transition to private coverage.

Currently, healthcare costs eat up around 18% of our nation’s GDP, the Medicaid program lost $21.9 billion to bad payments in 2011 alone, and Medicaid recipients still receive subpar care. Medicaid expansion without reform will put our state on the hook for more than we can afford in the future, meaning vital state expenditures, like education, will be at risk, and we will still have a system that fails to deliver cost-effective and quality care to those who need it.

Missourians deserve better than half-baked solutions from their elected officials. With thorough research and deliberation, we can craft a healthcare solution that works for Missourians, and will continue to do so in the future.

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.

House Refuses to Expose Budget to Budget Busting Medicaid Expansion Threat

Often, we look retrospectively at decisions we have made.  I am sure you can think of a time that you made a decision that was, in hindsight, not such a great one.  While speaking with constituents about government activity in Jefferson City or Washington, D.C., I often hear, “Why did they not see that coming?” Many times it is true; the government waits until it is too late to make the right decisions because of political consequences.  This week, your Republican-led legislature made a strong commitment to not giving in to the politically-expedient, easy path and made a decision that was in the public’s best long term interest.

 

Old Medicaid Expansion

The left, and those who do not take a long term, responsible economic view, have a grand, new idea on how to drastically diminish your kids’ and grandkids’ future earnings in the name of “doing the right thing” and “doing the smart thing”.  It is called Medicaid Expansion.  The idea has been to utilize more borrowed federal money to make promises to able-bodied adults that they will have “free” healthcare.  Never mind that Medicaid has poor health outcomes and trying to use a Medicaid card to gain access to a doctor’s office might as well be nothing more than handing someone a piece of plastic worth nothing. 

 

At the state level, Democrats have jumped for joy.  Governor Nixon and his liberal allies in the legislature think it is the greatest economic package they have ever seen.  So, for history’s sake, let us recall how many times on the campaign trail our governor proposed expanding Medicaid as the smart thing to do.  The answer is zero.  In fact, in each of Governor Nixon’s years in office before this one, he never once said that expanding Medicaid eligibility was the “smart” or “right” thing to do.  Apparently, it is only smart and right if the federal government pays for it with billions of dollars of more borrowed money.

 

A Budget Buster

 

Instead of being smart or right, this proposal actually adds billions to the federal deficit and exposes Missouri to more reliance on the federal government which, as a recent highly respected economic publication pointed out, places our triple-A credit rating in danger. The Democrats’ plan for Medicaid expansion has the potential to significantly reduce the amount of revenues available for future legislators to be able to appropriately fund long-term priorities like an educated citizenry.  This week, your Republican-led legislature was forward thinking.  Instead of giving in to the easy option of forsaking your future for today’s politically easy choices, we voted to be wise, prudent, and fiscally-responsible.  Those are mandates you sent us here to live up to.  Those are mandates we will uphold.