This article first appeared in the St. Louis Beacon, Aug. 14, 2013: One by one they came to sit in front of the special House committee to deliver their three-minute remarks. Most had same message: Expand Missouri’s Medicaid program.
The lopsided testimony came from dozens of health-care professionals, civic activists and ordinary residents during Wednesday’s daylong hearing of the Interim Committee on Citizens & Legislators Working Group on Medicaid Eligibility and Reform.
The meeting room was packed, with dozens of people standing along the walls because all 130 seats were filled.
After spending weeks traveling the state, the panel was holding its last hearing at St. Louis Community College’s Forest Park campus.
Set up in June by House Speaker Tim Jones, R-Eureka, the panel is to provide information to the House’s Interim Committee on Medicaid Transformation, which will develop the actual legislation.
A similar Senate panel was holding a hearing Wednesday in Jefferson City.
It's unclear how much impact the House hearing -- or the others preceding it -- will have. Based on the few questions asked by panel members, there appears to be a variety of opinions on Medicaid expansion.
But Jones and other Republican legislative leaders have made clear that they don't support the idea -- unlike Gov. Jay Nixon, a Democrat. As a result, some of today's witnesses privately expressed skepticism as to how much of an impact their testimony would have. But they showed up anyway.
Various witnesses laid out their hopes of how the Medicaid expansion could work under the federal Affordable Care Act.
Tops on several lists was the prediction of more treatment for low-income people suffering from mental illnesses, who now languish in prisons as criminals or as homeless people in the streets. Margaret Benz was among several nurse practitioners who said that the expansion could help reach many uninsured who now don’t get treatment or show up in the emergency room at greater costs to taxpayers.
Krista Ward, senior director of Medicaid for Express Scripts, the St. Louis-based pharmacy-benefit manager, said that Missouri could save a lot of money if it revamped the state’s Medicaid program so that prescription drugs were handled under managed care.
Tracy McCreery, manager of public policy for PROMO, Missouri’s statewide advocacy group for LGBT rights, said that gays and lesbians stand to benefit from the expansion because many cannot now obtain insurance through their partners' employers or family members and can't afford it on their own. PROMO also hopes that the insurance exchange -- not yet set up in Missouri -- might also help.
Mary Clemons, president of Women’s Voices Raised for Social Justice, said the expansion was the right and moral thing to do for 300,000 Missourians who could qualify for coverage.
“Missouri has one of the stingiest Medicaid programs in the country,’’ she said, noting that the state now only covers adults who earn no more than 19 percent of the federal poverty level – or under $2,500 a year. Under the expansion, coverage would be extended to adults who earn up to 138 percent of the federal poverty level.
States that agree to the expansion will see the federal government cover the added cost for the first three years, and at least 90 percent thereafter. Supporters at the hearing cited federal figures showing that the expansion could reduce the federal deficit, via more efficient and less costly health-care spending.
One of the few dissenters on the witness list was former state Sen. Jim Lembke, R-Lemay, who contended that the current Medicaid program could threaten the state’s solvency. “I don’t believe the numbers. I don’t believe we can trust the government,’’ said Lembke.
Instead, he cited estimates from the conservative Cato Institute that up to 30 percent of the current Medicaid spending reflects “waste, fraud and abuse.”
He’d prefer to see a federal and state overhaul, with Medicaid money “block-granted’’ to the states, which then would have the freedom to design their own health-care program for the poor and disabled.
Some in the audience loudly murmured their disapproval, prompting committee chairman Noel Torpey, R-Independence, to threaten to toss out members of the audience if they continued to be disruptive.
The crowd quieted down. And the parade of Medicaid supporters began once again to go to the mikes.
