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Nixon to try new approach to expand health care

This article first appeared in the St. Louis Beacon, March 7, 2009 - Missouri Gov. Jay Nixon plans to take another stab at expanding health-care access on Monday when he unveils a plan that, according to the talk circulating at Democrat Days, involves increasing hospital payments into the federal reimbursement allowance program.

Initially set up in 1991, the program is basically an assessment on Missouri hospitals, with the money used to collect federal Medicaid dollars -- which often are doled out to states at roughly a a three-to-one ratio.

Nixon declined to get specific during a news conference Saturday after he addressed hundreds of Democrats attending the regional Democrat Days in Hannibal.

But the governor and his aides did say that his Monday announcement, which is to be in St. Louis, will be another attempt at increasing health-care coverage to low-income adults and children. And they also didn't discourage speculation that his new proposal will involve the federal reimbursement allowance program.

As it stands, Nixon repeatedly has said, the 2005 Medicaid cuts by the Republican-led Legislature and then-Gov. Matt Blunt not only eliminated coverage for tens of thousands of low-income Missourians -- but also touched off higher hospital costs from more low-income use of their emergency rooms, and higher insurance premiums for Missourians who still have health care coverage.

The use of money from the federal reimbursement allowance program could be a way for Nixon to avoid using Missouri's general revenue money, which the Republican-led Legislature controls. Increasing the hospitals' payments might be acceptable to them, some sources say, if they end up getting more money back through federal matching funds.

So far, GOP leaders have blocked Nixon's proposal to increase the state's general-revenue spending for the federal State Childrens Health Insurance Program (commonly called SCHIP) by slightly more than $200 million, in order to obtain close to $600 million in federal matching funds.

But although Nixon had issued a strongly worded statement last week decrying the state House's vote to reject his plan, he avoided making any partisan shots about the issue during Saturday's brunch speech. In fact, he made only general references about the state's longstanding political fight over health insurance.

Instead, Nixon hammered away in his remarks about the importance of action in the state Senate on his proposal to expand Missouri's Quality Jobs program, which offers tax credits to companies if they expand their workforce by providing jobs with wages above the county average and with health-care coverage.

Although his proposal sailed through the state House weeks ago, it has been snagged in the Senate by a dispute over the state's various tax-credit programs.

"It's time for the Senate to quit thinking 'politics' and start thinking 'work,' '' Nixon said in his speech.

Nixon said the Senate's continued delay will cost Missouri jobs that end up in other states that have tax incentives. "Deals after deals are out there ... to get people back to work,'' Nixon said. "I want Missourians working.''

Afterwards, Nixon said he also plans to soon press publicly for the state and the Legislature to "get serious about worker training."

Jo Mannies is a freelance journalist and former political reporter at St. Louis Public Radio.