GROWTH OF MISSOURI'S SPENDING PUTS STATE IN BUDGET SQUEEZE

So the budget won't be the relative garden party that it has been these last eight years. "State budget has $300 million shortfall," read the big black headline in Thursday's St. Louis Post-Dispatch. It is, one lawmaker on the budget committee said, the biggest hole in the budget in a generation.

This, as much as any of the lavish plaudits he won on his untimely demise that tragic October night, is the legacy of Mel Carnahan. Increase spending year-on-year for each of eight years, an average of $921 million each year, during times of plenty. Increase spending at a rate of 7 percent per year, or three times faster than the rate of inflation. Take the state budget from $9.3 billion in 1993, Gov. Carnahan's first year, to $16.7 billion in 2000. The two most recent budget years showed the highest growth in state budget history, with a $1.5 billion increase from 1998 to 1999 and an additional $1.6 billion appropriated for 2000. Sign onto new spending at a dizzying rate, foremost among them a huge new expansion of Medicaid into the middle class called MC-Plus.

At Gov. Carnahan's behest, the Legislature enacted this Medicaid expansion at the very time we were successfully reforming welfare. (It is also the same time that, with welfare rolls dropping, at Mel Carnahan's department of social services employment spiked above 10,000 for the first time ever.) A family of four with income of over $50,000 qualifies for this new form of Medicaid.

Physicians, dentists and other Medicaid providers tell me that now a school principal with full benefits and her husband also employed at a job with health insurance bring their children in for care, fully signed up for MC-Plus, on the taxpayers. (That MC-Plus doesn't pay the physician or dentist anywhere near his cost in caring for that patient is someone else's problem. It's "free," you see.)

These folks aren't using the private health insurance plan at their respective places of employment, with its deductibles and co-pays, because the government has taught them well in habits of dependency.

Four years ago, during the debate on this huge new open-ended entitlement, a few of us warned against it. This writer stood on the floor of the Senate and decried an existing Medicaid system that didn't pay a dentist any more than 28 cents on each dollar of his or her usual and customary costs for giving treatment. (Gee, I wonder: Could this be why so few take any Medicaid patients at all, or why so many are now drastically limiting or having to drop the few they now do treat?)

Rather than enact a huge new expansion of Medicaid, we argued, shouldn't we pay those few heroic physicians and dentists who were taking Medicaid patients something closer to the real costs they incurred?

Such arguments availed us nothing, and MC-Plus passed easily. Vote no, you see, and you're open to the charge that you're "against children's health care." Today, in what looks like the tip of the budgetary iceberg -- if I'm wrong I wish someone would point out where -- Medicaid is $61 million in deficit.

By the way: Next year the federal money funding this Medicaid expansion runs out and it's all dumped on the state. Somewhere, the editorial writers who urged passage of this stuff are readying another piece decrying the cynicism of citizens who are sufficiently turned off by government not to vote.

~Peter Kinder is an assistant to the president of Rust Communications and a state senator from Cape Girardeau.