JEFFERSON CITY - House lawmakers are poised to send Gov. Matt Blunt's proposed Medicaid cuts to the governor's desk. A vote could come as early as Friday when the time for debate is set to expire.
Discussion opened Wednesday on the governor's cuts, which would knock tens of thousands of Missourians off Medicaid. Democrats rallied to amend the bill but their efforts were rebuffed repeatedly by a united Republican majority. Any changes in the legislation would require it to be sent back to the Senate where it was ensnared in an 17 hour filibuster last month.
Medicaid is a joint program between the federal and state government which provides health care to the poor, elderly and disabled. It covers nearly 1 million Missourians and accounts for more than a quarter of the state's expenses.
The bill, SB 539, is a companion to Blunt's proposed budget. Together they're part of a Republican push to overhaul a state program the governor and other Republicans describe as out of control. They say the cuts, which would drop an estimated 100,000 people in total from Medicaid rolls, are unavoidable without raising taxes or cutting education funds. They cite Missouri's budget shortfall, which estimates place between $600 million and $700 million.
Besides scaling back a number of services, the law would eliminate the entire Medicaid program in 2008. A commission of legislators would be charged with developing recommendations for alternatives. After that the General Assembly would then have to come up with a replacement system before the old one died off.
House Democrats rose often to criticize the cuts as cruel but none offered an alternative method for closing the budget gap.
"It's the governor's job to lead and he's failed to come up with a comprehensive vision for Missouri's health care," said House Minority Leader Jeff Harris, D-Columbia. "Don't cut senior citizens off of health care and then set up a commission. You've got it backwards."
Throughout the 1990s, Missouri's Medicaid rolls swelled. When the late Democratic Gov. Mel Carnahan took office in January 1993, just over 510,000 Missourians were enrolled in the system. According to the state's latest estimates, nearly 1 million are covered today. The nearly 40 year old program's $4.8 billion price tag accounts for more than 28 percent of the current state budget.
During his campaign last fall, Blunt said cutting back on Medicaid eligibility would be inappropriate. Now he says it's the only way to avoid raising taxes.
House members in favor of the cuts described the bill as bringing reform to a bloated system.
"This is what we are trying for with this bill, is to have something that's reasonable and fair, that puts the priority on those who are most in need," said Rep. Jodi Stefanick (R-St. Louis County), the bill's handler.
The measure before the House would reduce state spending by:
>Knocking down the eligibility line. Only singles who earn less than 74 percent of the poverty line and couples who earn less than 82 percent would qualify.
>Ending the requirement that the state pay for "optional" services like wheelchairs, prosthetics, dental work and eye care. They could still be funded through appropriations but there would be no guarantees. House Republicans have come up with a way to pay for some of these programs in early drafts of the budget.
>Eliminating the Ticket to Work program, which covers 9,529 people who earn their benefits working part-time.
>Ordering an annual audit of the eligibility of all recipients, who would be required to provide proof of income or risk losing coverage.
>Opening the door for recipients to be charged premiums and co-payments for services.
The bill would also cut state payments made to adoptive parents who make more than 200 percent of the poverty level.
Earlier in the day, a crowd rallied at the Capitol's south steps to protest the cuts. The protestors marched to the governor's office where they chanted and sang until Blunt's chief of staff, Ken McClure, agreed to a closed doors meeting.