A cure for Medicaid

By Jason G. Crowell

The Problem

Our state is adding 140 recipients to Medicaid rolls every day. Nearly one in five Missourians are on Medicaid. That is almost 1 million people, which is more than the number of kids in our public schools.

When Medicaid began in 1968, it accounted for less than 4 percent of the state budget. Now Medicaid spending tops a whopping 23 percent of the state budget, more than we spend on kindergarten-12 education.

For far too long we have measured compassion in Missouri not by the quality and access to health care we offer the less affluent, but by the number of souls we bind to our state's Medicaid welfare rolls. This is wrong. We must realize that anyone we help off of welfare by extending a hand up and not a handout is compassion and a success. It is not compassionate nor a success to add a soul to a cycle of dependency on welfare with no hope for the future.

The common-sense solution

Facing these facts, the Missouri House of Representatives has passed the 2004 Medicaid Welfare Reform Act, which is House Bill 1566. This common-sense package strikes a proper balance between stemming the growth in optional Medicaid services by making them subject to appropriation and preserving state dollars for education, the disabled and the elderly.

This welfare-reform package would remove less than a fifth of 1 percent of middle-class children currently on the Medicaid welfare rolls. The bill would remove less than 1 percent of healthy, able-bodied adults from the Medicaid welfare rolls and would adopt Gov. Bob Holden's own proposal to establish consistent asset limits across the board for Medicaid programs by changing the asset limit on the CHIP program from $250,000 to $25,000.

This means that an eligible child whose parents still have up to $25,000 in the bank and earn up to 300 percent of the federal poverty level -- for a family of five, this is $60,000 -- would still be eligible.

The bill would close a Medicaid loophole that allows Missourians with hundreds of thousands of dollars in assets to shelter these resources in annuities and get on Medicaid.

The bill would strengthen efforts to ensure that only those Missourians who are eligible for Medicaid are placed on the welfare rolls, and it would root out waste, fraud and abuse.

We also recognized that individuals are more likely to care about the quality and cost of their health care if they participate. So we codified into state law federal guidelines governing cost sharing that ensures copayments from 50 cents but not to exceed $3. Under the bill, no Medicaid welfare recipient would ever spend more than 5 percent of their income to pay for their own health care.

Even though most Missourians with private health insurance pay hefty premiums and copayments, the governor says that a 50-cent copayment would result in 20,000 kids not participating in the program. For this to occur the parents of these children would have to choose to terminate their child's coverage. If a parent terminates health insurance for a child over 50 cents, then shame on the parent, not shame on the taxpayer for not picking up the tab.

Finally, in order to address the lack of access to health care around the state, we are proposing an additional $2 million investment in clinics like Cape Girardeau's Cross Trails Medical Center that would allow us to draw down from the federal government an addition $4 million to $6 million for rural health care.

The governor's solution is to increase taxes on Missourians by $522 million dollars and spend over half of that on welfare expansion. Missouri can not spend what it does not have. We cannot run a deficit. So when we pass a budget, we must live within our means and appropriate only those funds we have available.

Continuing to expand our unsustainable welfare system will ensure it will collapse under its own weight. Missouri has to slow the growth of our welfare system now, or it will bankrupt us in the future and deny our children the right to a quality education and hinder our ability to extend a hand up for the most needy: the disabled, elderly and children born into poverty.

I invite the Missouri Senate to stand with the House by sending these common-sense reforms to the governor for his signature.

Jason G. Crowell of Cape Girardeau) is the state representative for District 158 and is the majority floor leader of the Missouri House Representatives.