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Health See other Health Articles Title: Medicaid expansion lost in debate - State policymakers fear massive tax hike to fund it. A big component of President Obama and congressional Democrats' plans to reduce the number of Americans without health insurance is a massive expansion of Medicaid coverage to low-income adults making less than $14,404 a year. But the proposed Medicaid expansion has become somewhat lost in the national debate about whether the federal government should set up a public insurance plan to compete with the private sector. The U.S. House version of the current health care reform legislation would expand Medicaid to people making up to 133 percent of the federal poverty level; the Senate bill goes further, to 150 percent. In Missouri, the current income cap is 20 percent, or $292 a month for a family of three. The Medicaid expansion has not been lost on some Missouri's policymakers who say that without full federal funding, it will wreak havoc on the state budget and possibly trigger the need for a massive tax increase. "It will be a budget buster for the state," said Lt. Gov. Peter Kinder, a Republican who has been criticized for supporting former Gov. Matt Blunt's controversial 2005 Medicaid cuts. The Department of Social Services estimates an expansion to 133 percent of the poverty level would grow Medicaid costs in Missouri by up to $1.3 billion a year. Based on current costs, DSS says up to 249,832 low-income adults would get added to the Medicaid rolls, costing the state up to $454 million a year without full federal financing. Nationwide, the House bill would add 11 million more Americans to the Medicaid entitlement program, costing $438 billion over 10 years, according to the Congressional Budget Office. As currently written, the House bill would provide 100 percent federal funding through 2014 and then drop down to 90 percent in 2015, the last year specified in the legislation. "We certainly would hope that the federal government would help us ease that in if that's going to be the requirement," said state Rep. Sara Lampe, a Springfield Democrat who supports expanding existing government programs to cover the uninsured. But state budget writers have little hope that the federal government won't eventually break its promise to pay for a Medicaid expansion and pass along what the Democratic governor of Tennessee has described as "the mother of all unfunded mandates." "Sooner or later -- this is what they typically do -- they back out and leave us holding the bag," said House Budget Chairman Allen Icet, R-Wildwood. Gov. Jay Nixon, a Democrat who campaigned for three years on reversing Blunt's Medicaid cuts, is noncommittal when asked whether he supports the current proposal in Congress to mandate increased Medicaid eligibility nationwide. "The bottom line is we want to see them move forward. The status quo is not where we want to be," Nixon told reporters Thursday after the annual Governor's Ham Breakfast at the State Fair in Sedalia. "I think the one action we don't want is inaction." "Untested" public plan When Congress reconvenes next month, members will return from a month long recess filled with town hall forums across the country where citizens have expressed concerns about a government-run insurance plan and the current health care system. Obama has already said he could live without the public plan. Some believe Obama and Democratic leaders in Congress may have to start over from scratch, leaving the Medicaid expansion, cost cutting to the Medicare health insurance for the elderly and other reform components in limbo. "My guess is after this summer, almost all of this is going to have to be revisited," said U.S. Rep. Roy Blunt, R-Springfield. "The response from the public has been so dramatic on this that they're going to have to go back and look at this in such a substantially new way." U.S. Rep. Ike Skelton, D-Lexington, said there are so many proposals floating out of Congress right now, he hasn't examined the Medicaid portion yet. "Mark Twain once said, 'the more you explain it (to me), the more I don't understand it,'" Skelton said. Skelton said he's spent his summer vacation "collecting concerns" from health care professionals and people across the 24-county 4th Congressional District, though he's been criticized for not hosting any town hall meetings. The 32-year veteran congressman has his own concerns about how the overall bill is paid for and whether it will actually contain health care costs for Americans who already have private insurance plans. "As far as I know, it's pretty untested," Skelton said of the public plan. "According to some experts ... some say it will cause more competition, some say it will absolutely eliminate competition. I don't know. Frankly, it concerns me a great deal." Given that public backlash has been against the public plan and reducing Medicare expenditures to pay for the more subsidized health care for the uninsured, some think the Medicaid expansion stands the best chance of surviving the legislation process this fall in Congress. "It's my belief, that's one of the things that will probably stay. People will not confuse (Medicaid) with creating a public plan," said Sen. Charlie Shields, president pro tem of the Missouri Senate and a hospital executive from St. Joseph. The best solution? During the recent legislative session, Nixon and the Republican-controlled Senate pushed a plan to expand Medicaid eligibility to 50 percent of the poverty level -- $763 a month for a single parent with two children -- at no cost to the state. The state's hospitals association offered to pick up the state's $52 million tab in order to draw down $92 million in federal funds and insure 35,000 low-income parents. Nixon wanted to expand Medicaid; Shields and the Senate wanted to create a state-subsidized private insurance program to encourage individuals to buy into their own health care future rather than leaning on taxpayers to pick up the tab. But the Republican-controlled House balked at both plans, refusing to reverse course on the 2005 Medicaid cuts, which resulted in about 100,000 people being thrown off the welfare program and 300,000 getting their benefits reduced. In hindsight, a Medicaid expansion to 50 percent would have better prepared the state for an "inevitable" federal mandate, Shields said. "I like the plan we had, because it was based on a private option," Shields said. Senate Appropriations Chairman Gary Nodler questions why the federal government would want to use Medicaid to reach the uninsured, given the program's history of bankrupting states. "If you already have a system that isn't working financially ... by expanding it to include a larger number, I don't see how that doesn't make the whole fiscal problem worse," said Nodler, R-Joplin. "You just grow the unfunded liability. That's not a solution to this."
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