Last week, the Missouri House Committee on Government Oversight and Accountability voted 7-2 to pass House Bill 700, a proposal that would expand Medicaid eligibility, but short of the levels that the Affordable Care Act (ACA) proscribes. The media has variously described the proposal as an “expansion” and an “alternative,” and Democrats and Republicans alike — depending on what they want to see in the measure — can and have described it as both. In view of that rhetorical ambiguity, it is unsurprising then that not only was committee support for the bill bipartisan, so, too, was its opposition.
Rep. Kevin McManus, a Kansas City Democrat, pointed out that Health and Human Services Secretary Kathleen Sebelius has repeatedly said states couldn’t get full federal funding unless they fully complied with the national law. That’s why he was one of two lawmakers to vote against the bill in committee.
Joining him in opposition was Rep. Mark Parkinson, a St. Charles Republican who said he could not support the bill because of an ideological opposition to the federal health care law. Three times, he said, voters in his district have rejected Obamacare. The first was a ballot measure in 2010 on the individual mandate. The second was last fall’s ballot measure on health insurance exchanges. The third was a vote against President Barack Obama’s re-election.
The committee had previously voted down an attempt to amend HB 700 to actually implement a full Medicaid expansion. That was not altogether unexpected, either; the House has been stalwartly opposed to an ACA Medicaid expansion as both standalone bills and amendments. Suffice to say, I share their skepticism and concerns about the program.
As to HB 700 itself, my views about the proposal have been documented; the legislation has some good points, including reforming some aspects of how Medicaid is delivered. But it seems in some respects to bow to a perceived political reality that more has to be spent on the program for reform to be passed. I do not agree with that view. Medicaid reform is a good unto itself that policymakers of all stripes should be able to get behind. Moreover, I worry that in the process of HB 700’s continued legislative sausage-making that we ultimately will find the state passing a law that, inadvertently or purposefully, actually expands and implements the Medicaid program under Obamacare. The governor is still pushing for that, and by keeping the increased spending aspect a live wire, I am still concerned about this possibility. Indeed, if this compromise legislation moves any further in the expansion direction, it will be right and truly compromised.
The perfect need not be the enemy of the good, but I am not yet convinced the pavestones of this legislation are leading us someplace Missouri voters want to be. Stay tuned.
