Yesterday the Missouri House Government Oversight and Accountability Committee correctly rejected House Bill 627 which would have implemented the Obamacare Medicaid expansion by a vote of 5-2.  Your over 8,000 emails made a difference!

The hearing was conducted yesterday.  For over an hour and a half, those who wanted more government spending which adds to the national debt gave their testimony imploring the committee to take the “free” federal money.

After all this testimony, I was able to provide the sole testimony in opposition to the expansion proposal.  A summary of my testimony can be found here. The take away is that there is no such thing a “free” money.  It’s a fairy tale – not all fairy tales have happy endings!

While the Government Oversight and Accountability Committee voted down HB627, the House Appropriations – Health, Mental Health, and Social Services also rejected an amendment to add the expansion dollars to the budget.  All in all a good day for fiscal responsibility.

A couple of bills have been proposed to reform the current broken system.  Representative Dr. Keith Frederick has proposed one of those bills.  HB608 contains a number of innovative reform ideas that should be discussed.

Today, Representative Jay Barnes introduced House Bill 700.  It’s a good attempt to transform Missouri’s current Medicaid system into a market-based  system. Or at least as close as one can come with any government program.

It changes eligibility for the state program (pages 6 and 7) reducing the number of people eligible in the state. It removes some people from the program and adds others.  All in all, about 140,000 people will be added.

Some will say that’s a bad thing – expanding people on Medicaid.  While that might appear to be a bad thing on the surface one would be missing the fact that by reducing the overall eligibility statewide, future growth of the Medicaid roles will be limited.  That’s a good thing.

The proposal makes the Medicaid system more market driven.  Recipients will get to choose their insurance company rather than the state doing it for them at no additional cost to taxpayers.  Recipients will also be made responsible financially for their health care decisions through several mechanisms in the bill.

The basic structure with some modifications is actually pretty good. What is not good is that the proposal depends on the Obamacare Medicaid expansion dollars even though it is not the Obamacare Medicaid expansion program.  That’s a non-starter!

The transformation should not use Obamacare Medicaid money.  It should instead identify either the amount of federal match necesary to make the program work and make it part of the necessary waiver. Or, added populations should be removed to make the current match work.

HB700 is a good concept – bad funding source!

The opportunity to reform Medicaid has never been better.  HB608 and HB700 contain some very good ideas that should receive careful consideration and action.  The outcome should not include using the Obamacare Medicaid expansion dollars