Last week Governor Nixon did a dog and pony show announcing his support of the Obamacare Medicaid expansion for Missouri. He plans to put it in his budget when he presents the State of the State next month. Republicans have been very solid in their resistance to the proposal. They are correct in their position!

History shows that these government “freebies” are anything but free. Even Democrat Governor Warren Hearnes pointed out when it was first passed that Medicaid would bankrupt states at some point. He was right. Missourians could not afford the government expansion of Medicaid that occurred in the 1990’s and they can’t afford Obamacare expansion either.

The fact of the matter is that all the nice things you hear about Medicaid just aren’t supported by the facts. When Missouri reformed Medicaid in 2005 and Missouri Healthnet was created, it was to accomplish all those things that you are hearing the expansion of Medicaid would do except it reduced the Medicaid rolls. People on Medicaid were supposed to be healthier because of the preventive care aspects. Emergency room visits and costs were to be reduced because of the preventative care measures etc, etc, etc. Few if any of these things have actually happened.

Doctors have by and large stopped taking Medicaid patients. My personal physician and his partner are one of the few who will take new patients and they are reaching the point they can’t afford to do it either. Obamacare will exacerbate this problem by reduced payments for services and by creating a doctor shortage. Doesn’t really do you any good to have Medicaid if you can’t get access to a doctor. So what does that leave? Emergency room visits. They are still the routine.

Republicans are often their own worse enemy. One need only look at what is happening in Washington and the alleged fiscal cliff. Republicans have folded in the past and the likelihood they will do so again is pretty high in many people’s mind. Compromise is a necessary function in life. The problem comes in compromising principle and some don’t seem to know where that line is.

That’s why I found the commentary by Dave Helling in today’s Kansas City Star to be interesting. Dave points out that the Republicans are now supporting requiring non-profits who engage in campaigns to disclose their donors. It is true Republicans did not agree with this idea a couple of years ago. It think it is also accurate that they do so now only because some were attacked by pop-up non-profits.

The legislature being political creatures are subject to feel good measures like this one. They can stand-up and say they are adding transparency but they don’t really address why the pop-up non-profits popped up! It’s not because donors are cowards but because they have seen the results of retaliation and attacks by not only liberal groups but from conservatives as well. It’s a “fix” that merely treats the symptom but leaves the disease unchecked.

At any rate, Dave uses this “flexibility” as a possible indicator that Republicans will cave on Medicaid expansion. I don’t think there is a correlation but he makes some points that are potential problems for Republicans.

Rural hospitals are one of the attack points. No one should be confused – hospitals negotiated the reduction in payments in exchange for MANDATORY Medicaid expansion. The Supreme Court dealt them a blow as they should have. The hospitals had no authority and absolutely NO right to negotiate such a deal. Now, rural hospitals will likely suffer for the deal made by the big guys.

Here’s a solution to the problem. The legislatures should re-work the formula for distributing the Federal Reimbursement Allowance (FRA) that hospitals pay into as a tax on themselves. This money is then used by the state to draw down additional federal money and re-distributed to hospitals. The legislature should change the distribution formula to favor the rural hospitals even more than it does now. This would at least in part make up for the bad deal the big guys cut that may have an impact on rural hospitals.

Republicans need to hold strong for their constituents as a whole and not special interest groups. They should not expand Medicaid!