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Will Nixon’s new strategy to expand Medicaid in Missouri work?

jay nixon 81814
Bill Greenblatt | UPI

After two years of failing to convince Republican lawmakers to expand Medicaid in Missouri, Gov. Jay Nixon is pitching an alternative he hopes will sway enough of them to come aboard. But key Republicans remain cool to the idea.

Nixon, a Democrat, unveiled his new proposal Wednesday at appearances in Springfield and Kansas City.

The big difference from earlier pitches? Medicaid recipients would have to work, or seek work, to qualify for the most affordable coverage. Unemployed recipients would be referred to career centers and those that find a job or actively look for work would receive reduced premiums.

Recipients who refuse to work or seek employment would pay higher premiums under Medicaid.

Medicaid recipients could also face financial penalties if they call for ambulance services in non-emergencies. There would also be financial rewards and incentives for making healthy life choices, such as dieting and giving up tobacco. Employed recipients would also have to pay for a portion of their health care.

Nixon says many of these proposals are already in use in other Republican-led states, including Arkansas, Pennsylvania, and Michigan.

But will the new approach work?  So far, it doesn’t look that way.

House Speaker John Diehl, R-Town and Country, told reporters Thursday that Nixon’s latest Medicaid pitch didn’t sound any different to him than past proposals.

“I read with a certain sense of déjà vu the governor’s comments,” Diehl said. “As he did last year, he decided to use state resources to fly down to Springfield to make a pronouncement about a different approach that he’s going to take on Medicaid, rather than walking about 200 steps here in the building to actually meet with the General Assembly and legislative leaders.”

Diehl added, “If the governor is serious about it, I suspect we’ll see a plan from him, an actual plan, and not just a press availability, and we’ll see what that is and react accordingly.”

Senate leaders have yet to comment on Nixon’s revised proposal, but based on strong opposition from several socially conservative Republicans it may not matter.

Rob Schaaf, R-St. Joseph, famously tweeted back in December, “Let me be crystal clear: We won’t be expanding Medicaid.”

And Senate Majority Floor Leader Ron Richard, R-Joplin, continued to throw cold water on the idea after Thursday’s adjournment.

“If (Medicaid expansion) had life (in the Senate), we would have started talking about it some months ago,” Richard told reporters.  “Unless a group of people come to me that say they have a deal on (Medicaid) reform or expansion, then we’ll talk about it, but they have not.”

GOP backers of expansion still making no progress

Some of the proposals, including cost-sharing of coverage and financial incentives for healthy living, have been floated before by a handful of Missouri Republican lawmakers who presented it as expanding and reforming Medicaid at the same time.  An attempt in 2013 by stare Rep. Jay Barnes, R-Jefferson City, made it through its first committee but was never brought to the House floor because of strong opposition in the Senate.  Last year, a similar bill was filed by former state Rep. Noel Torpey, R-Independence, but his bill never received a hearing, despite being scheduled for one.

Torpey left office last year before his term ended.  Barnes, now in his fifth year as a House member, has moved on to other issues, mainly ethics reform.

The only Republican lawmaker still championing Medicaid expansion is state Sen. Ryan Silvey, R-Kansas City. His proposal last year was similar to those proposed by Barnes and Torpey, combining a modest expansion with reforms to Missouri’s Medicaid system (known as MoHealthNet). It came too late in the 2014 session to be filed as a bill, but Silvey gave up on the option of adding it as an amendment elsewhere due to strong opposition from fellow Republicans.

Silvey is trying a few different approaches this year. He’s sponsoring one bill to turn MoHealthNet into a block grant program. Another would expand Medicaid but for only military veterans in Missouri and no one else.  Both bills have been assigned to committee but neither have received a hearing yet.

Follow Marshall Griffin on Twitter:  @MarshallGReport

Marshal was a political reporter for St. Louis Public Radio until 2018.