Medicaid overhaul passes to governor after legislative OK

JEFFERSON CITY, Mo. -- Two Bootheel Republicans broke with their party and Gov. Matt Blunt on Thursday to oppose a Medicaid overhaul bill that authorizes the elimination or reduction of health-care services for many low-income Missourians.

After two days of debate in which Democrats branded the proposal as "cruel" and "immoral," the GOP-led House of Representatives passed it 89-69. Because the House made no changes to the bill as approved by the Senate last month, it heads directly to Blunt, who intends to sign it into law.

On largely party line votes, House Republicans defeated 18 amendments Democrats offered in attempts to soften the bill's impact. State Rep. Lanie Black, R-Charleston, voted with the minority party on most of those proposals.

"I got involved in politics because I wanted to leave my children a better state and nation," Black said. "I can't do that if every dollar of general revenue this state collects has to go for health care for the needy."

State Rep. Otto Bean, R-Holcomb, said he is concerned cutting back on Medicaid will devastate small rural hospitals in the Bootheel that serve large numbers of recipients.

"My constituents say they don't like the bill, so I'm voting the wishes of my district," Bean said.

Just six House Republicans, including Bean and Black, voted against the bill. Two Southeast Missouri senators -- Rob Mayer of Dexter and Kevin Engler of Farmington -- were the only Republicans opposing the measure in the upper chamber.

Rep. Terry Swinger, D-Caruthersville, was on an excused leave from the House due to a death in his family.

Because of the large number of Medicaid recipients in his legislative district, state Rep. Gayle Kingery, R-Poplar Bluff, initially had serious reservations about the bill. However, he eventually decided it was essential to controlling state spending.

"This is something that has to be done," Kingery said.

Blunt has proposed $626 million in core cuts to Medicaid, a program which is still expected to cost the state in excess of $5.3 billion during the fiscal year beginning July 1. His budget plan would save $231 million in state money, but force Missouri to forgo $395 million in federal funds. Opponents say taking nearly $400 million out of the state's economy will have a devastating ripple effect and cost the state jobs.

More than 100,000 low-income Missourians would lose Medicaid benefits under the proposal.

The bill approved on Thursday would make optional a number of services the state is currently obligated to provide, such as eyeglasses, wheelchairs, prosthetic limbs and dental care. It would also require nominal co-pays for certain services.

Medicaid would cease to exist as of July 1, 2008. The bill authorizes creation of a special legislative committee to develop a more streamlined program to replace it before the current program expires.

In the meantime, Medicaid recipients would be subject to more thorough eligibility reviews in an attempt to weed out those not truly in need of benefits.

The bill moved at an incredibly swift pace by legislative standards. From the first Senate hearing on the measure to final passage by the House, a mere 15 working days elapsed. Considering its sweeping impact, it was also unusual that House leaders made it a point to keep any changes from being made, which would have sent the bill back to the Senate.

Democrats complained the state is shirking its obligation to care for the sick, disabled and elderly.

"Nothing that is unethical and immoral can be good public policy," said state Rep. Beth Low, D-Kansas City.

House Speaker Pro Tem Carl Bearden, R-St. Charles, said community groups, churches and individuals should step forward to care for the needy.

"State government does not have a moral obligation to provide these services," Bearden said.

The bill is SB 539.

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