Capitol Perspectives: Missouri’s Medicaid history

July 9, 2021 8:00 am
Protesters at Medicaid expansion rally

Demonstrators stand outside of the Governor’s Mansion in Jefferson City on July 1, 2021 and hold signs urging Gov. Mike Parson to fund voter-approved Medicaid expansion (Tessa Weinberg/Missouri Independent).

The Missouri legislature’s recent special session on Medicaid involves a dominant state issue with a long and fascinating history.

It begins in 1945 when President Harry Truman called for a national health insurance program.

Twenty years later, Congress added two health-care provisions of Truman’s vision into the Social Security law. It was signed by President Lyndon Johnson in Truman’s Missouri home town of Independence with Truman present.

One part is Medicare that covers health costs for persons over the age of 64 years, regardless of income, and others with specific health-care issues.

Just like Social Security, there is a payroll tax to cover the costs.

In a way, Medicare is a federal government-run health-care savings account for your retirement years.

In contrast, Medicaid covers those unable to afford health insurance or pay medical bills — without a payroll tax to cover future costs.

Unlike Medicare, Medicaid is a partnership with states to administer and partially finance the program in return for much larger matching federal dollars, so long as a state complies with federal Medicaid rules.

States can refuse the partnership. Arizona did not implement a Medicaid program until 1982 — nearly two decades after the federal Medicaid program was created.

A major expansion of Medicaid occurred in 1997 when Congress approved the Children’s Health Insurance Program to provide coverage for children in families with higher incomes.

In 1998, then-Missouri Gov. Mel Carnahan won legislative approval to fund the CHIP program that expanded Medicaid coverage to children with families below 300 percent of federal poverty level — more than $60,000 in today’s dollars for a family of three.

It was a highly partisan issue. In both Missouri’s House and Senate, a majority of Republicans voted against the measure, citing a GOP theme of “Medicaid for millionaires.”

The growth of Medicaid costs has become an increasing problem for the state budget.

In the middle of the 1980-1981 fiscal year, Missouri State Auditor Jim Antonio warned that rising Medicaid costs would exceed what the legislature had appropriated.

It has become common that in Missouri Medicaid requires a supplemental appropriation in the second half of a budget year because the initial appropriation failed to fully cover rising Medicaid costs.

I’ve suspected lawmakers deliberately passed an underfunded Medicaid appropriation to make “welfare” spending appear smaller knowing they later would have to pass additional Medicaid funding in a supplemental appropriations that gets less news coverage.

In 2005, Republican Gov. Matt Blunt won legislative approval for Medicaid coverage cuts that legislative budget staff estimated would toss more than 40,000 from Medicaid coverage. Some news reports cited a much higher figure.

Two years later, a revised plan restored some of those cuts in a measure that renamed the state Medicaid program to MO HealthNet — a term I do not use in my stories since most of the money for the program comes from the federal “Medicaid” program.

Years later, Senate Appropriations Chair Kurt Schaffer, R-Columbia, echoed what I had heard from other budget experts that a major problem was the rising cost of prescription drugs covered by Medicaid because of new and highly expensive medications.

The biggest step to try to control the growing Medicaid costs has been to funnel Medicaid coverage through managed care companies which has led to criticisms about coverage difficulties for recipients.

Simply cutting Medicaid coverage is not as simple as you might think.

Hospitals, nursing homes and large numbers of Missourians who rely on Medicaid include the elderly and medical institutions in Republican rural areas.

Some of the elderly on federally-funded Medicare also get state Medicaid coverage for nursing home costs which are not covered by Medicare.

It makes Medicaid more than just a “welfare” program supported only by Democrats.

In fact, one of every six Missourians receives Medicaid.

These are just a few Medicaid issues. In future columns, I’ll explore issues involving financial tricks, partisan politics and women’s health care.

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Phill Brooks
Phill Brooks

Phill Brooks has been a Missouri statehouse reporter since 1970, making him dean of the statehouse press corps. He is the statehouse correspondent for KMOX Radio, director of MDN and an emeritus faculty member of the Missouri School of Journalism. He has covered every governor since the late Warren Hearnes.