158th hopefuls split on Medicaid

Editor's note: Cape Girardeau voters will select a new state representative in a special election Tuesday. This is the third in a series of articles designed to familiarize voters with the three candidates' stands on some of the important issues that the winner will face during the legislative session, which is already underway.

By Rudi Keller

Southeast Missourian

For most of the past two years, Will Richardson of the SEMO Alliance for Disability Independence has worked to reverse the Medicaid service and eligibility cuts enacted in 2005 at the urging of Gov. Matt Blunt.

The effect on working people with disabilities has been particularly severe, Richardson said. By changing the income standard for eligibility -- coverage was once extended to a single person with a disability with an income of $24,000 or less -- many people dependent on public subsidies for their health care were forced to choose between keeping their coverage or keeping their job, he said.

The new income standard eliminated coverage for people with an income greater than $3,504 a year. And while lawmakers relaxed that standard last year to create a program called "Ticket to Work," Richardson said fewer than 1,000 of the 3,000 people statewide targeted by the program are enrolled.

Tuesday's special election to fill Cape Girardeau's seat in the Missouri House, the three candidates have taken dramatically conflicting stands on whether to restore the 2005 cuts or enact some other method to provide coverage.

Republican Mary Kasten, hoping to return to the House after a seven-year hiatus, has said she understood the need to balance the state budget, but that she supports restoring some people to the program. Democrat Mike Keefe, the former Cape Girardeau postmaster, said he wants to restore eligibility to the previous standard and explore ways to help Missourians without health insurance obtain affordable coverage. And Libertarian Steve Kinder, a pharmacist, said the program should be cut further to eliminate coverage for able-bodied people, but that the working disabled should be supported in their health needs.

One of the arguments used by Blunt when pushing for the cuts was that the Medicaid program was riddled with waste and abuse.

Richardson doesn't dispute that some people were taking advantage of the system and some people were receiving care who shouldn't, but he said the remedy was far worse than the problem.

"The abuse was not nearly as widespread with the consumers as with the providers," he said. "What they did was the equivalent of saying 'look, someone stole a pig in the village' and they shot everybody in the village to make sure they got the person who stole the pig."

$500 million surplus

The fight this year in Jefferson City is over the best way to expand coverage to uninsured Missourians. Sitting on a $500 million budget surplus, Blunt is proposing increased payments to doctors and other providers. And he wants to start, as quickly as possible, an initiative called Insure Missouri. Blunt proposed spending $347 million in state, federal and private funds to provide private health insurance. Blunt estimates that 200,000 of the 719,000 uninsured Missourians would have care by 2010. But some lawmakers in both parties have questioned both its projected costs and effectiveness.

Medicaid was one of the showcase programs of President Lyndon B. Johnson's War on Poverty. Enacted in 1965, it is a shared state and federal responsibility. A state's share of the cost is based on the income of its residents. In Missouri, for every $1 spent by the state, the federal government kicks in $1.50.

For the upcoming year, the program is estimated to cost $5.1 billion out of a $23 billion state budget.

As a result of the 2005 changes, 990 Cape Girardeau County adults, or more than 40 percent of the total, in the Medical Assistance for Families program lost their medical coverage. The decline in coverage for other groups, such as children, has been less dramatic, but significant numbers of people in the county no longer have coverage. There were 5,269 adults enrolled in Medicaid, including pregnant women, nursing home patients and the disabled, in 2005. In November 2007, that number had fallen to 4,207.

According to figures supplied by the Missouri Department of Social Services, restoring all services and income guidelines to their pre-cut levels would cost $707 million in the fiscal year beginning July 1. Of that amount, $266 million would come from state funds and $441 million would come from the federal treasury.

In 2007, the state replaced the old Medicaid system with a new program called MO HealthNet. The program emphasizes preventive care and requires each recipient to have a "health-care home," either a clinic or a doctor who is responsible for managing their care.

Some of the changes enacted with MO HealthNet are creating problems, said Susan Wallis, executive vice president for VIP Industries, Cape Girardeau's sheltered workshop. Prescription drugs have become a big issue for employees at VIP, she said. "During this changeover, through someone's infinite wisdom, they decided to change everyone's providers," Wallis said. "They got letters after the fact that their prescription provider has been changed, and they can't get their medications or they have to pay full price."

One lawmaker whose votes show a conflict over the cuts is state Sen. Jason Crowell. He voted in favor of the changes in 2005, then in 2007 during debate on MO HealthNet, voted for an amendment to restore the benefits and income standards to the previous levels.

Crowell's biggest questions about Insure Missouri are whether it can deliver to his constituents. He wants to know whether a provider network will be in place that provides access to quality care.

"The last thing we need to put in place is a system that is unsustainable in the long term," Crowell said.

Candidate positions

In the only forum for candidates in Tuesday's special election, the differences over the course of policy was clear.

Kasten noted that some elements have been restored, and that there are still some changes that are needed. "We need to investigate the fraud," Kasten said. "The governor had the obligation to balance the budget."

As to adding money to restore the cuts, Kasten said she's uncertain about her stance. "Anyone that genuinely needs government services like Medicaid should be able to receive those services. The Medicaid system was reformed by the legislature and reforms are an ongoing process."

For Keefe, the $500 million surplus is an indication that the state has the money to restore benefits to most people cut from the Medicaid rolls. "Maybe there are people who should not have the benefits, but if we can get $400 million and it is going to cost us $200 million, where I come from that is a good investment of money."

Those who were cut are seeking care in emergency rooms, Keefe said, foisting higher costs on everyone else when the bill is not paid. He sees the expansion of benefits as cost control for everyone. "It would help to reduce premiums for working families that are buying insurance," he said.

The problem with restoring benefits, Kinder said, is that too many people who are able to work but won't will still have benefits even with restricted eligibilty. "I see young, strong people every day who have their prescriptions paid for by Medicaid because they choose not to work."

The disabled are a different matter because of their vastly higher medical costs, Kinder said. "They should be able to earn as much as they want and be given aid according to their need."

rkeller@semissourian.com

335-6611, extension 126