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Nixon optimistic that Missouri Republicans may come around on Medicaid expansion

This article first appeared in the St. Louis Beacon, Feb. 20, 2013 - Missouri Gov. Jay Nixon struck a note of optimism Wednesday about his push to expand Medicaid in the state, even as the Missouri House has excised the proposal – and the $2 billion in federal aid – from the budget for the coming fiscal year.

At an appearance in St. Charles County, the governor said, “It’s pretty clear to me we’re making progress, first of all. I think that progress will be seen by next week in the House when that Republican majority introduces a measure to move forward in this area.”

While he doesn’t expect the GOP bill to “be exactly what we would want,’’ Nixon, a Democrat, said the fact that House Republicans were focusing on health care was, nonetheless, “a concrete step to move forward.”

Nixon even avoided any criticism of state House Speaker Tim Jones, R-Eureka, who has been outspoken in his opposition to the expansion – and made frequent verbal jabs at the governor.

“Speaker Jones has appointed a committee to look at this, they’re doing solid work,” said Nixon, who met privately with the speaker earlier this week. “I think Speaker Jones continues to look at these issues. I think he also is seeing the economic impact of moving forward.”

Reminded of the hefty criticism directed at his Medicaid proposal at last weekend’s statewide GOP gathering in St. Louis, the governor added with a chuckle, “If I just worked with politicians based on what they said at their political rallies, and pounded on the table, I wouldn’t get anything done in this job.”

Nixon cites other GOP governors' support

Speaking broadly, the governor observed, “The challenge we’ve had is to escape the binary choice that happened in November (during the election), when you were ‘fur it or agin it.’ “

What has helped, he said, is that several Republican governors in other states – Nixon cited John Kasich in Ohio and Rick Snyder in Michigan – recently have decided that their states will participate in the Medicaid expansion called for in the federal Affordable Care Act, the signature legislation of President Barack Obama’s first term.

Referring to the GOP governors, Nixon said, “They’re doing this – not because it’s the easiest thing to do politically. They’re doing it because it’s the right thing to do.”

Nixon appeared before a generally supportive crowd of businesspeople, health-care professionals and educators at the St. Charles County Economic Development Center. The stop was the latest in a series around the state to promote the proposed Medicaid expansion.

The governor’s chief talking points have been that:

  • The federal government has promised to pick up the entire tab for three years;
  • Missouri is projected to gain an estimated 24,000 new health-care-related jobs in just the first year;
  • And adding 300,000 more Missourians to Medicaid rolls would result in a healthier workforce and more economically stable hospitals.

On Wednesday, Nixon also described the $5.7 billion in federal dollars that would be sent to Missouri to cover the first three years of the expansion as money that originated in Missouri taxpayers’ pockets.
Beginning in 2017, the state would take on a share of the costs, which would be phased in -- but not exceed 10 percent by 2020.

“The question before us is a narrow one,” the governor said. “Will we bring the tax dollars we send to Washington back home to strengthen our Medicaid system here in Missouri? Or will we let those tax dollars that Missourians send to Washington be sent to other states to spend?”

“Other states get the benefits. We get the bills,” Nixon declared.

He emphasized that the 300,000 added to the Medicaid rolls would be largely “working Missourians who simply can’t afford health care…can’t afford to go to the doctor’’ and who end up in hospital emergency rooms if they become seriously ill.

Such scenarios drive up the costs for hospitals forced to care for people without insurance, he said, and for insured Missourians hit with higher premiums that are used to offset the costs of the uninsured.

“Seizing this opportunity is good common sense, good fiscal sense,” Nixon added.

So far, the Republican-controlled General Assembly hasn’t been buying that pitch – even with pressure from rural hospitals, which are warning that they may close if the Medicaid expansion fails to come to pass in Missouri.

Jones and other Republican leaders maintain that government should have less involvement in the delivery of health care, and the federal government is too broke to advance such an expansion of an entitlement program.

A shift in the GOP's anti-Medicaid mood?

But some of Wednesday’s attendees thought that the political mood may be changing. “It sounds like the momentum is building for support of this initiative,’’ said Gregory Prestemon, chief executive of the St. Charles Economic Development Center.

He was struck by Nixon’s list of business supporters, which includes the Missouri Chamber of Commerce and a number of local affiliates. Prestemon noted that he hadn’t heard before of their endorsements.

Laura Heebner, chief executive of Crider Health Center – which serves the uninsured in St. Charles County -- said she’s also seen a slight shift.

A few weeks ago, when she was in Jefferson City, Heebner said that Republican legislators flatly said there was no way they would support Medicaid expansion – “period.”

But during her latest visit, Heebner was told, “Well, if the bill comes to me, I will read it.”

Even that slight change is giving Heebner some hope: “I think the conversation is shifting.”

Nixon observed that even Republican critics “certainly don’t want Washington running our health-care system.”

“And if we don’t move forward on this,” he asserted, billions of Missouri health care dollars will go to Washington “and they’re making the choices.”

Jo Mannies has been covering Missouri politics and government for almost four decades, much of that time as a reporter and columnist at the St. Louis Post-Dispatch. She was the first woman to cover St. Louis City Hall, was the newspaper’s second woman sportswriter in its history, and spent four years in the Post-Dispatch Washington Bureau. She joined the St. Louis Beacon in 2009. She has won several local, regional and national awards, and has covered every president since Jimmy Carter. She scared fellow first-graders in the late 1950s when she showed them how close Alaska was to Russia and met Richard M. Nixon when she was in high school. She graduated from Valparaiso University in northwest Indiana, and was the daughter of a high school basketball coach. She is married and has two grown children, both lawyers. She’s a history and movie buff, cultivates a massive flower garden, and bakes banana bread regularly for her colleagues.