Health care funding plan fails, but sponsors perceive progress

Close doesn’t count, except in horseshoes, hand grenades and, according to Gov. Jay Nixon, health-care initiatives in Missouri.

Nixon’s proposal to expand the state’s Medicaid program was well received in the Missouri Senate, but the House let the legislation die on the last day of session.

Although Nixon and Rep. Mary Still of Columbia believe progress was made, one political observer said the result can only be considered a failure and believes the Democratic governor oversold his ability to get the measure through a General Assembly controlled by Republicans.
Former Gov. Matt Blunt and the legislature decided to cut Medicaid eligibility in 2005, leaving about 100,000 people without benefits. One of Nixon’s centerpiece campaign promises was to restore the Medicaid funding.

Democrats have called the move by Blunt and other Republicans both cruel to low-income people who were cut from the program and fiscally irresponsible. Medicaid funding advocates argued that cutting the health-care program for the poor cost the state hundreds of millions of dollars in federal matching funds and forced low-income people into hospital emergency rooms for care.

Republicans, who controlled the legislature, defended the 2005 cuts as the only way to forestall an impending state budget shortfall. And many GOP lawmakers have railed against what they saw as a fiscally irresponsible allocation of state funds in the wake of an uncertain budgetary future.

Even after the 2008 election cycle pushed Nixon into the governorship, GOP lawmakers made up a solid majority of the Missouri General Assembly. That meant Nixon’s task was to persuade some of the same lawmakers who made the cuts in the first place to change course.

So Nixon made a new pitch earlier this year to bring a percentage of those displaced in 2005 back into the program. Unlike his original plan, which used several hundred million dollars’ worth of state general revenue to restore the program, his new proposal was to use contributions from hospitals and federal matching funds to put roughly 35,000 people on Medicaid.

But Republicans in the House rejected two different versions of the governor’s proposal that were passed by the Senate, arguing that Nixon should be doing more to provide health insurance to individuals with pre-existing conditions. House leaders also expressed unease at expanding what they saw as a “welfare” program.

“Our problem is we have an entitlement crisis in this nation and in many of the states,” Rep. Tim Jones, R-Eureka, said earlier this month. “Do we want to be like California, which has a $40 billion hole over the next five years? That’s twice the size of this state’s budget. Do we want to be like our comrades to the east in the People’s Republic of Illinois with a $12 billion hole?”

“Guess what happens when you ramp up the spending and you increase the programs to the point where you fall off the cliff?” Jones added. “When you fall off the cliff, there’s no money left. And guess what’s going on in Illinois? They’re not paying their Medicaid providers.”

Other Republicans pointed to heavy-handed tactics by Nixon’s office. Two first-term lawmakers accused a gubernatorial aide of implying the possibility of a future appointment by voting favorably on a budget bill incorporating Nixon’s plan. Both the governor and his aides have denied that any quid pro quo occurred.

Before the session started, Nixon said Republican lawmakers in both chambers were steadfastly against rescinding the eligibility cuts. The fact that a revised plan made it out of the Senate and nearly landed on his desk was an accomplishment, he said.

“I think we have succeeded in… keeping this issue in the forefront,” Nixon said.

But at least one political observer doesn’t see a silver lining.

“I put it down as a failure,” said George Connor, a political science professor at Missouri State University.

Nixon, Connor said, placed the bar too high during his campaign in promising to rescind the cuts. He said the pledge to rescind the Medicaid cuts was made with full knowledge that it was unlikely to find favor in a Republican-controlled legislature.

And even though Nixon eventually decided to achieve his pledge incrementally, Connor said it happened too late in the process to make a difference.

“Each time the proposal was tweaked, we were lowering the expectations on health-care reform,” Connor said.

Still, a first-term Democrat, said there was some benefit in getting the ball rolling on at least a partial solution to the Medicaid issue.

“We have to redefine progress in this environment,” said Still, a former spokesperson for Nixon who serves on a committee dealing with health insurance legislation. “It takes a while for people to understand. And the fact the hospitals came forward with a plan, and the Senate Republicans agreed with it, and it didn’t cost the state a dime [it] provides a framework for discussion that we can carry through the summer and through the fall.”

“In one sense, it’s easier to pass legislation in the first session than it is in the second,” Connor said. “The Republicans in the House are going to be running for office. He’s going to have a harder time passing health-care reform in January because they’re going to be running for re-election.”

“I think his best bet is going to be scale down, scale down until he gets something that’s acceptable to members of the House,” Connor added. “By that time, people who supported [Nixon] are going to argue that it’s too little, too late.”