Mo. GOP lawmaker advances Medicaid expansion

JEFFERSON CITY, Mo. -- A renegade Republican teamed up with minority party Democrats on Wednesday to deliver the first affirmative -- albeit symbolic -- vote of the year for a plan to expand Missouri's Medicaid program to hundreds of thousands of lower-income adults.

House Health Insurance Committee chairman Chris Molendorp voted with four Democratic members to attach the Medicaid expansion proposal to an unrelated Senate bill pending in his committee. Molendorp said he planned to do the same thing to any other Senate bills sent his way before the May 16 end of the legislative session.

A Republican from Belton who is not seeking re-election, Molendorp has been at odds with a majority of his GOP colleagues who remain firmly against expanding Medicaid eligibility under the terms of President Barack Obama's health-care law.

His committee voted 5-2 for the expansion plan, with the other Republicans on the panel either voting "no" or leaving the room before the vote. An affirmative vote typically would advance a bill to the House Rules Committee and then, potentially, to the House floor for debate. But Molendorp acknowledged that Republican leaders are unlikely to allow the bill to be debated by the full chamber.

The committee vote was intended "to make a statement that the Republican Party needs to do the right thing," Molendorp said. He added: "It's symbolic, I understand that, but someone's got to lead on this issue, and that's what I'm doing."

Under the federal health care law, states that expand adult Medicaid eligibility to 138 percent of the poverty level -- about $27,000 annually for a family of three -- can initially receive full federal funding for those added to the rolls. That federal aid is then gradually reduced to a 90 percent share, with states picking up the rest.

About half the states have chosen to expand Medicaid eligibility.

Many Missouri Republicans, who hold overwhelmingly majorities in the House and Senate, have raised concerns about the long-term costs of an expanded Medicaid program once the state has to start paying part of the bill.

The House and Senate both have repeatedly rejected Democratic attempts to add funding for a Medicaid expansion to the state budget.

The plan endorsed by Molendorp's committee was developed by Republican Sen. Ryan Silvey, of Kansas City, who has been unable to get it debated by the full Senate. It's been pushed by a coalition of health care and business groups whose lobbying corps includes former Republican U.S. Sen. Kit Bond, of Missouri. Supporters describe the plan as a conservative approach to Medicaid expansion.

Silvey calls the measure a comprehensive overhaul of Missouri's Medicaid and welfare programs. It would use managed care insurance policies administered through the Medicaid program to cover adults living in poverty, with new incentives for healthy behaviors and requirements for some participants to make co-payments. For those living slightly above the poverty level, the state would subsidy premiums through a federally run health insurance website.

Among other things, the bill also would require food stamp recipients to seek work, further their education or engage in community service.

Joe Pierle is CEO of the Missouri Primary Care Association and chairman of the Coalition for Healthy Economic Growth, which is backing a Medicaid expansion. He said the committee action was the "first positive vote since the session started" in January but acknowledged the measure is "tied up in politics" with no clear path to passage.

"How you disassociate this from Obamacare is the biggest obstacle," Pierle said.

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Health care bill is SB524.

Online:

Legislature: http://www.moga.mo.gov

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