04.02.21
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Past issues are available in the Media Library.
It’s been a hard week.
A majority of the House Budget Committee rejected a special bill, House Bill 20, that would have carved out funding for Medicaid expansion. Despite heated debate, a majority of the House later defeated expansion. Also this week, the House rejected an amendment to House Bill 11 providing an alternative to the unnecessary cuts included in implementing a Medicaid outpatient fee schedule by a 69-79 vote. H.B. 20 was unnecessary, as no other Medicaid eligibility category is funded through a separate bill. The failure of the H.B. 11 amendment — despite it offering relief from the hospital cuts while holding the state’s general revenue budget harmless — was more a lack of imagination.
Yes, the path for these issues has become more limited. However, both remain possible. While the House is the body charged with originating spending bills, the Senate has an equal role in crafting the state budget.
In the next several weeks, we’ll find out whether the Senate will act as a “necessary fence” to the “fickleness and passion” we experienced in the House budget process this week.
The words in quotes above are not mine. James Madison used these terms when explaining to the U.S. Constitution’s framers the important bulwark that the U.S. Senate would provide to balance the actions of the U.S. House. As in Washington, it also is so in Jefferson City.
Support of either or both are not assured in the Missouri Senate. Hospitals will need to continue to press our case. As will other stakeholders.
On Medicaid expansion, lawmakers have heard from health care providers, advocates and business leaders, among others. However, the states’ Medicaid Managed Care insurers — who stand to gain much from expansion — have not put skin in the game. More voices, including those who supported expansion but live in counties where it did not pass, must be heard. There’s a lot at stake. In polling conducted by MHA earlier this year, Missouri voters overwhelmingly believe that the legislature should follow the will of the voters.
The outpatient fee schedule is not flawed by design; it has merit in streamlining and simplifying a complex system. But the pending proposal is reimbursement cuts masquerading as “reform.” Real reform is possible and, if implemented in a deliberate and thoughtful way, desirable. However, this will take the types of partnerships we’ve had with the state for 30 years with the Federal Reimbursement Allowance.
For the Missourians who voted for Medicaid expansion in August of 2020, and the low-income Missourians who could gain coverage through the adopted constitutional mandate, the expansion vote was a repudiation of their voice and the importance of health care in improving lives.
Providing value for Missourians — as state and federal taxpayers — will require more than saying no. Most health care costs don’t simply disappear, they shift. Building a better system — with expansion and within the existing program — will take vision, trust and a belief that the program itself and those who enroll are not themselves unworthy of our collective investment. Or, as one Missouri Senator called them — “moochers.”
This week’s message from a majority of the House was that they didn’t trust Missourians or support something that would benefit all of their hospitals. After a year of rising to our best to serve this state, that’s very disheartening.
Politics is about values. This week demonstrated how out of alignment values can be.
Let me know what you’re thinking.
Herb B. Kuhn
MHA President and CEO
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