Supporters of big government spending and trampling of state’s rights want us to believe that the healthcare battle is over with the re-election of the President. Boy are they in for a shock!

The reality is that most of those supporters know that the battle is far from over. They are merely trying to convince those not paying too close attention that it is. For those of us who are paying attention, our job is equally important to educate people on the fact that the battle still rages as outlined in this Forbes article.

Two major healthcare issues – healthcare exchanges and Medicaid expansion – face the Missouri 97th General Assembly as it convenes on January 9, 2013. In reality, the two issues are intertwined.

Too many people have the idea that healthcare exchanges are automatically bad. The concept for exchanges is actually pretty sound. The Missouri legislature has worked on trying to establish an exchange for over a decade long pre-dating Obamacare exchanges. The reason Missouri didn’t already have a healthcare exchange is because we – I was in the legislature at the time – couldn’t figure out how to implement one that wasn’t more (big) government and didn’t impede the market.

The Obamacare exchange whether state or federal makes anything we considered look like RC racing cars going up against NASCAR’s Carl Edwards! A state exchange today must meet the requirements of Obamacare in order to be approved. Certainly a federal implemented exchange would be even worse. However, I fall into the camp that says the feds don’t have the money to implement an exchange in the states who refuse to implement one and that roadblocks won’t be laid out in Congress to slow or eliminate exchanges. The 97th General Assembly should reject implementing a healthcare exchange!

The Supreme Court decision upholding the individual mandate as a tax did have the silver lining saying the feds did not have the Constitutional authority to “compel” the states to expand Medicaid by withholding existing funding. We have reason to believe that the legislature will refuse to expand Medicaid as the taxpayers can’t afford it under any conditions.

The Kansas City Star has an article about this issue. It reiterates the voice of many legislators that Medicaid will not be expanded. It also highlights the pressures that legislators will be under from their local hospitals to do just that – expand Medicaid for their financial benefit. DO NOT underestimate this pressure!

The hospitals through the American Hospital Association (AHA) negotiated reductions in reimbursements to the hospitals in exchange for Medicaid expansion. Their original “negotiation” was that states would be “forced” to expand Medicaid ensuring they wouldn’t miss out on any money. These un-elected people from the hospitals “agreed” to bigger state government spending on behalf of the state legislatures without the consent of those legislatures or the taxpayers of the states!

There may be rural hospitals that are put into tough binds. The blame is already being attempted to be placed on the Republican majorities in the General Assembly for creating the situation by refusing to spend like the federal government – money they can’t afford. The fact is any rural hospital that will be put in those tough situations will be there because of the “big” boys who negotiated away their payments. The “big” boys may have to limit their future expansion projects to one or two cranes or limit their CEO pay raises.

Now that their “negotiated” deal has been dealt a setback by actually putting the decision back in the hands of those elected to make it rather than the un-elected hospital consortium, they are up in arms with the prospect of not receiving the payments from expanded Medicaid program in Missouri. The General Assembly should not bow to the pressure of these special interests who had no authority to negotiate such a bad deal on the legislatures behalf!

Let the hospitals understand that when you make a deal with the Devil – he always gets the better end of it!