Senate Republicans begin Medicaid debate, despite filibuster

JEFFERSON CITY, Mo. -- Republican senators on Monday promoted Gov. Matt Blunt's plan to kick nearly 90,000 people off Medicaid as an intermediate step to revamping what they described as a bloated and broken government health-care system for the poor.

Democrats vowed a filibuster as debate began on legislation enabling much of the governor's plan.

"We will not stand by for these cruel cuts," said Sen. Pat Dougherty, D-St. Louis. "I do not consider these individuals expendable to balance our budget."

Blunt contends the cuts are necessary to boost spending for public schools without raising taxes. Republican legislative leaders plan to bring the bill to a vote before departing for their annual spring break at the end of the week.

But Democrats counter that Republicans are doing things backward by cutting people off Medicaid before waiting for the results of a commission, created under the bill to recommend Medicaid reforms by Jan. 1.

Blunt's budget proposal would remove about 9 percent of Missouri's 1 million Medicaid recipients by tightening the eligibility standards for low-income parents, the elderly and disabled. It also would eliminate some Medicaid services -- such as dental and eye care, wheelchairs and prosthetics -- for all but children, pregnant women and the blind. Plus, it would require more Medicaid recipients to make co-payments each time they visit a doctor or hospital.

Although the state's $5.3 billion Medicaid budget is still growing, the governor's office contends its plan would save $625 million during the fiscal year that starts July 1. He cites a report from the National Association of State Budget Officers concluding that Medicaid consumed 30.7 percent of Missouri's total expenditures in the 2004 fiscal year -- more than every state except Tennessee.

"What we're trying to do is not politically popular," said Sen. Chuck Purgason, R-Caulfield, lead sponsor of the legislation. But "it is something that must be done for the long-term viability of our state and our most vulnerable citizens."

Sen. Jason Crowell, R-Cape Girardeau, called Missouri's Medicaid program "bloated, swollen."

"The red flags are waiving, the alarm bells are blaring," he said. "Missouri's Medicaid system is on a path to bankruptcy."

Among other things, the bill would authorize a reduction in the eligibility threshold for the disabled and elderly, currently set at the federal poverty level -- $9,570 for an individual. Blunt's plan would cut that maximum income threshold to about $7,082 annually; a Republican-led House appropriations committee has endorsed a plan setting that threshold at $8,135 per year for the elderly and disabled.

The House committee also voted last week to continue providing some services Blunt proposed to eliminate -- namely hospice care, ambulance rides and wheelchairs -- for low-income parents, the elderly and disabled. But the bill pending in the Senate still would delete those from a list of required Medicaid services.

The Senate legislation serves as the authorization for cuts to be made in the budget, but does not in all cases require those budget cuts to occur.

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Medicaid bill is SB539.

On the Net:

Legislature: http://www.moga.state.mo.us