JEFFERSON CITY - A key plank to the governor's plan to increase education spending without tax increases by focusing substantial cuts to the state's welfare system cleared its final hurdle Thursday.
The bill, one of the most hotly contested items in a legislative agenda that pushed for changes in the civil liability system, the Southwest Missouri State University name-change and wholesale changes to the worker's compensation system, would tighten eligibility requirements to remove 89,000 from the Medicaid rolls.
Republican proponents said the changes, which could reduce coverage for another 20,000 Missourians were necessary to fund proposed increased to the K-12 education without tax increases.
"Is it moral to force an individual to provide the daily bread for his neighbor," Rep. Jim Lembke, R-St. Louis County, said.
Medicaid, with almost 1 million participants, is the state's largest welfare program. It is a joint state-federal program providing health coverage for the low-income, elderly and disabled.
Rep. Brian Yates, R-Lee's Summit, said the program, which ballooned during the 1990s as more people were added to the rolls and more ineligible participants sought state aid. Yates said dead, out-of-state and ineligible people receiving benefits had caused its cost to spike, requiring changes.
But opponents, which included all the Democrats in the legislature and a handful of Republicans in both the House and Senate, said the cuts were too deep.
"It brings tears to my eyes to see these things taken away from my people," Rep. Craig Bland, D-Kansas City, said.
Major provisions of the bill include cuts to eligibility and dictating Medicaid coverage of specific types of health care in the budgeting process. The current system dictates care such as dentistry, podiatry and eye exams must be covered. Under the new law, such things might not be covered if the General Assembly does not provide the money to pay for them.
Republicans pointed to this provision as proof the cuts were focused on people abusing the system and would have a minimal impact for people legitimately involved in the program.
"This bill, with very few exceptions, will cut no one off Medicaid," said House Speaker Pro Tem Carl Bearden, R-St. Charles.
In the budget, which will hit the House floor next week, podiatry will not be covered and cuts were made to dental coverage and a program designed to provide limited home care for people with disabilities to permit them to work. In addition, the MC+ program, which covers children in families earning up to three times the federal poverty level who do not qualify for Medicaid but lack traditional insurance, would require more participants to pay a premium. Officials from the Department of Social Services told the House Budget Committee they expected savings because more than 23,000 children would lose coverage because their families would not pay the premium.
Aside from providing an option on coverage, the bill would also eliminate the entire Medicaid program in 2008 while calling for a commission to create a new program and would add copayments and premiums.
"We are going to force the citizens, the (state) reps, the senators and the governor to come together and think outside the box to find a way to help those who can't help themselves," House Speaker Rod Jetton said.
Minority Leader Jeff Harris, D-Columbia, said there were too many problems with the bill to distinguish provisions that were the worst, but several House Democrats said they were particularly appalled with eliminating Medicaid without a suitable replacement.
"If there are a couple of people abusing or some instances of fraud, then we should throw out the system would mean that no corporation should be allowed to operate in America because of what Enron did," Rep. Rick Johnson, D-High Ridge, said.
Democrats tried repeatedly without success to amend the bill and thus force it to return to the Senate where a 17-hour filibuster stalled Senate action last month.
Jetton, R-Marble Hill, said he was concerned about floor amendments to the bill and had requested Republican lawmakers, with a healthy majority, rebuff attempts to amend.
Officials in the governor's office said Blunt will sign the bill this month.