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Despite Setbacks, Bond Isn't Giving Up Medicaid Expansion Fight

Jason Rosenbaum/St. Louis Public Radio

Former U.S. Sen. Kit Bond was tapped by the Missouri Chamber of Commerce to get Medicaid expansion across the finish line.

He didn’t succeed. Despite the attempts of several Republicans in the House and Senate to pass some form of expansion this year, Bond told St. Louis Public Radio on Monday that “we were just a few filibustering senators short of getting it done.”

That doesn’t mean the former Republican lawmaker is giving up the fight. 

“We’re going to lose $2 billion by not doing it this year,” Bond said after the groundbreaking of an expansion to the Donald Danforth Plant Science Center. “But we have no intention of quitting. Because this means too much to Missouri, and it means too much to the people who are losing health care.”

Under the Affordable Care Act, the federal government would pay the full cost of expanding Medicaid up to 138 percent of the poverty level — with the state gradually picking up the tab up to 10 percent. While Republican lawmakers have been opposed to expansion for various reasons, several GOP legislators floated proposals that would alter and expand the health care program.

Among other things, a plan floated by state Sen. Ryan Silvey, R-Kansas City, would have diverted money already being spent on Medicaid recipients to pay for the expansion when the federal match is reduced. The plan from Silvey — a former Bond aide — also would have encouraged Medicaid recipients to work and placed some patients into private insurance.

Bond said that while Silvey tried hard to get people on board with his proposal, “still some people were hung up on saying no, despite the fact that I believe we proved that we could take care of all the pressing health-care needs in the Medicaid area.”

Indeed, nearly a half-dozen Republican senators in March threatened to kill any Medicaid expansion. And when Silvey tried to amend his proposal onto another bill late in the legislative session, he faced opposition from state Sen. Rob Schaaf, R-St. Joseph. 

During an exchange on the Senate floor, Schaaf told Silvey that “if you’re wanting to expand Medicaid, which is really your true intent here, then really I’m just not that interested.” While Silvey said he tried to incorporate some of Schaaf’s ideas into his proposal, Schaaf responded there were “so many important reforms that you did not put in that I would be very disappointed about.” 

Credit Jason Rosenbaum, St. Louis Public Radio
Sen. Rob Schaaf, R-St. Joseph

“My major problem with your bill is that you expand health welfare. You put more people on welfare,” said Schaaf, who put forth legislation changing how new hospitals are approved and publicizing the prices of medical procedures. “I think it’s the wrong thing to do here. There are a lot of market-based reforms that would bring down the costs of health care.”

Bond said the consequences for inaction would be stark. Not only will the state not get $2 billion to pay for the expansion, but he also added health-care providers would feel the ripple effect.

“Hospitals are laying off people. Community health centers are shutting down,” Bond said. “That means for people of lower incomes, the only place to get health care may be the emergency room — which is terribly costly and inefficient and not healthy for them.”

Some lawmakers who threatened to filibuster Medicaid expansion — such as state Sens. Brad Lager, R-Savannah, and John Lamping, R-Ladue — won’t be returning to the Senate next year. Asked if Medicaid expansion will fare better because of that fact, Bond said: “I hope it will. But the problem is there’s going to be a lot of people without health care.”

“Some national studies say more people will die because they won’t have access to health care. It’s a frightening prospect,” Bond said. "You don’t know whether that’s going to happen. We do know that Missouri is going to lose $2 billion. And there are a lot of people — needy people — who are not going to get health care. And I worked for my entire career to make sure that we had a good health-care safety net.”

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