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Dempsey reiterates that Medicaid expansion will have 'problems' in Senate

This article first appeared in the St. Louis Beacon, Feb. 15, 2013 - Missouri Senate President Pro Tem Tom Dempsey has reiterated that any Medicaid expansion will be difficult to pass out of the Missouri Senate, a statement that comes as the state House presented its budget without any money for the expansion.

Dempsey, R-St. Charles, was one of a number of state legislators who took part in a forum Friday morning in Clayton hosted by Lathrop & Gage. An audience member asked the two-term lawmaker what he thought of the prospects for expanding the health care program, which Gov. Jay Nixon highlighted extensively in his State of the State speech.

“It’s got problems in the Senate,” Dempsey said. “The Senate Republicans are very concerned about the sustainability.”

The Medicaid expansion is a key aspect of the federal Affordable Care Act, also known as "Obamacare." Under the ACA, the federal government would fund 100 percent of the expansion from 2014 to 2016. After that, Missouri would gradually pick up a share of the cost until it pays 10 percent of the expansion by 2020.

The reason there's debate is that the U.S. Supreme Court ruled earlier this year that Medicaid expansion is optional. It's up to individual states to decide whether they want to participate.

The proposal in question would expand Medicaid coverage for all Missourians with incomes up to 138 percent of the federal poverty level, in line with the ACA's guidelines. Currently, most adult Missourians can make no more than 19 percent of the federal poverty level. Percentages are higher for children.

The upshot is that the proposed expansion is estimated to add close to 300,000 Missourians -- most of them people in low-wage jobs without insurance -- to the Medicaid rolls.

Proponents – such as Nixon – say the expansion will provide an economic development jolt and provide health care coverage to thousands of Missourians. But many Republicans in both legislative chambers have chafed at the idea, severely complicating its chances of passage.

Dempsey said on Friday – as he has in the past – that he has doubts that the federal government will sustain its end of the bargain.

“There’s just a real skepticism as to that being our only obligation,” Dempsey said. “And a number of the people that I served with had to reduce Medicaid spending in 2005 to address our structural budget deficit. Nobody wants to put people on a plan and then have to go and take them off the plan later on.”

He said that the federal government “is not a great partner to have,” adding that there are still plenty of unanswered questions about the ACA’s impact on insurance rates and businesses.

“They haven’t passed a budget in four years,” Dempsey said. “They’re borrowing over 40 cents on every dollar. And they have shown no ability to address their long-term budget problem. And we don’t want to enter into a partnership with the federal government when they are as dysfunctional as they are on budget issues. And a number of my colleagues feel that way.”

Dempsey’s comes as the leader of the House Budget Committee released an initial draft of the state’s budget without incorporating the expansion. That was noted by another participant at the forum, state Rep. Marsha Haefner, R-Oakville.

“We’re going to take a hard look at what we already do with Medicaid, try to fix the problems that we know exist and that providers know exist, take care of that first and then see how we can move forward,” said Haefner, a member of the House Budget Committee.

Rep. Mike Colona, D-St. Louis, took a dissenting view of sorts, noting that federal payments to cover uninsured patients at hospitals are expected to be phased out as part of the ACA.  The federal assumption is that the hospitals wouldn't need the payments because more people seeking treatment would have Medicaid coverage.

Those cuts are likely to particularly affect small rural hospitals in the state. Colona added that Republicans may take a different view of the issue when a hospital facility has to shut down because it lost the federal payments, and there's no expansion of Medicaid coverage.

“I think this is a situation where people say you get what you pay for. You know, we get the policies of the people we elect,” Colona said. “We can debate these bills all day long in Jefferson City. But in 2015 or 2016, when Jefferson Memorial closes because the money we get to reimburse us from the federal government gets slashed by two-thirds because we didn’t want to tackle Medicaid expansion, maybe then we’ll have a slightly different makeup in the General Assembly.”

A media advisory sent out on Friday said that House Minority Leader Jake Hummel, D-St. Louis, would be holding a news conference on Monday to announce the filing of Medicaid expansion legislation.

Other notes from the forum:

- Dempsey praised the Senate session thus far, noting the chamber’s work on a tax credit bill, changing how unemployment benefits are divvied out and what could be a major breakthrough on changing how the Second Injury Fund operates.

He said that senators got to work earlier than usual, holding a pre-session retreat in November instead of December and swiftly assigning bills to committees.

“Moving on those early was a help to convey that there’s a different way of doing things,” Dempsey said. “But there’s much more work to be done. And it’ll be how we finish that people remember.”

- Sen. Eric Schmitt, R-Glendale, once again touted his plan to lower taxes for businesses across the state.

Schmitt – an attorney for Lathrop & Gage who served as an emcee for the event – said that discussions about broad-based tax policy would continue this session, especially in light of Kansas’ aggressive cuts in corporat income taxes.

“We are on the clock now because what some of our surrounding states are doing, what they’re considering and what they’ve already done,” Schmitt said.

- Sen. Ryan McKenna, D-Crystal City, discussed a recently filed measure that would temporarily institute a one-cent sales tax increase to bolster transportation infrastructure. McKenna is co-sponsoring the initiative – which would need voter approval – with Sen. Mike Kehoe, R-Jefferson City.

Like Kehoe, McKenna said the initiative increase safety on roads, allow local communities to complete transportation projects and provide jobs for thousands of construction workers.

“This is an issue that transcends political party, ideology, geography,” McKenna said. “I think the proposal gives everybody a bite at the apple. And I think it’s just good policy to invest in our infrastructure.”

Near the end of the forum, McKenna was asked why he was pursuing a sales tax increase instead of boosting the state’s gas tax. In response, McKenna said that a roughly 30-cent increase would be necessary to fund the $1 billion worth of transportation needs.

“People would not like that,” McKenna said. “The issue of fuel tax is a regressive tax. I think we ought to get away from it altogether.”

- In addition to discussing efforts to reconfigure the state’s criminal code and touting the expansion of courts specifically tailored to handle DWI cases, Colona told the audience that the legislature should pass legislation that would add sexual orientation and gender identity in to the state’s non-discrimination statutes.

Colona, the only openly gay man in the Missouri legislature, said such a move could provide a boost to companies seeking high-level recruits to come to the Show Me State.

“I will tell you that every year I’ve been down here, we’ve had more and more cosponsors for this bill,” Colona said. “And I do think it’s just a matter of time before we get there.”

- In her remarks, Haefner signaled that she wasn’t enthralled with the aforementioned Senate bill aimed at easing the Second Injury Fund’s financial woes.

“I don’t think that raising taxes for any reason at all is going to be the solution to getting us out of this economic slump that we’re in,” Haefner said. “And I’m really upset about the workers’ comp solutions that have been come up with. I realize that we have to do something with the Second Injury Fund. But I feel bad for a lot of the small employers that are just hanging on by a thread for the last five years of the economy and now they’re going to get hit with this extra charge too.”

Among other things, the bill would allow the director of the Division of Workers’ Compensation to raise a surcharge on workers comp premiums of up to 6 percent in order to clear the backlog of payments from the fund to injured workers.

Jason is the politics correspondent for St. Louis Public Radio.