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Monday, 21 April 2014 00:00

Editorial: The Medicaid expansion argument is winning in Missouri

Written by  Editorial Board | St. Lous Post Dispatch
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When examining the recent successes of the Affordable Care Act, many of which were outlined by President Barack Obama in a speech last week, it’s difficult to settle on the most important number:

  • 8 million people have now signed up for private insurance on either the federal or state health insurance exchanges. This surpasses initial goals and creates a large enough marketplace to help cement Obamacare as a lasting change in health care policy.
  • 35 percent of those signups are people under the age of 35, which makes the economics of the Affordable Care Act work even better.
  • 3 million more people signed up for Medicaid programs because of new ACA incentives in states that have expanded their Medicaid programs. Medicaid provides free or subsidized health care to the poor, most of them working people, who live on significantly less than a living wage.

Missouri’s poor and working poor aren’t eligible. The Missouri Legislature — mostly because of the stubbornness of a few Republican senators who believe it is their duty to block Obamacare at every turn — refuses to expand the state’s Medicaid program.

That brings us to another number: 19.

That is the number of instances in the current or recent state budgets in which nearly every Republican in the state Legislature has already supported an element of Obamacare, whether they care to admit it or not.

Sen. Ryan Silvey, R-Kansas City, challenged Sen. John Lamping, R-Ladue, one of the chief opponents to expansion of Medicaid in Missouri, with this information during a debate on the Senate floor this month.

Here’s part of that debate:

Silvey: “So the idea of taking any money out of the ACA, unless it’s a block grant, that’s just a non-starter for you?”

Lamping: “Yeah … By no means do I believe we should further expand our financial relationships with the federal government.”


Mr. Silvey then asked Mr. Lamping about funding two specific programs in Missouri with federal dollars that are part of the ACA. One of them helps keep senior citizens at home rather than in nursing homes, which ultimately saves the government and health care industry money. Another increases reimbursements to doctors who take Medicaid patients, to try to increase overall access to health care. Mr. Lamping said he didn’t know enough specifics about the programs to get into a debate on the Senate floor.

Then this happened:

Silvey: “Let me share something with you senator. Those two items have been in the budget the past two years. You have voted four times to take about $120 million out of the ACA and put it into our broken Medicaid system.”

Lamping: “Then I made a mistake.”

The discussion laid naked the bankrupt intellectual argument, to the extent there ever was one, against expanding Medicaid in Missouri.

The mistake of Mr. Lamping, and of Sen. Rob Schaaf, R-St. Joseph, who also is fighting Medicaid expansion, wasn’t their earlier votes to help the working poor in their home districts. Their mistake was abandoning their intellectual honesty to oppose a program purely because they bought into the political argument that Obamacare had to fail at all costs.

That political argument has failed.

The latest Congressional Budget Office projections show reduced costs in coming years for the Affordable Care Act — and larger drops in the federal deficit as a result of the program.

Part of the reason for that is the increased economic activity created by the program, as billions of federal dollars buttress a health care industry that suddenly can meet the needs of millions more people in a meaningful way.

In Missouri, that economic impact could be profound, creating more than 24,000 jobs and actually adding money to Missouri’s general revenue budget. That’s according to studies that the opponents have failed to counter in any meaningful way.

Dr. Schaaf, like Mr. Lamping, has voted over and over again for budget items that are tied to Obamacare. Maybe they weren’t paying attention. But that’s hard to imagine in Dr. Schaaf’s case. He’s a physician who once touted the Insure Missouri plan pushed by Republican Gov. Matt Blunt, which, like the ACA, sought to increase access to health care to Missouri’s working poor.

Are we to believe that Mr. Lamping and Dr. Schaaf are so ideologically rigid that they will oppose a unique Missouri plan to adjust to the new Obamacare reality simply because they swore to oppose the legislation at every turn?

The playing field has changed. Not only have Mr. Lamping and Dr. Schaaf already done that which they said they’d never do — and been called out on it — but as the president said last week, “this thing is working.”

Mr. Lamping ran as a practical, intelligent man who would help represent the needs of a St. Louis region that is often ignored by the Republican majority in the Capitol. Nearly all of the top business and community leaders in St. Louis are begging for Medicaid expansion because they know of its clear economic and moral value to the city and the state. They need Mr. Lamping to represent them.

Speaking of moral values: Mr. Lamping, a devout Catholic, told us in 2010 that as a legislator, he would make “no decision without considering the impact on the least in society.” That was one reason why we endorsed his candidacy.

Last week, the Missouri Catholic Conference, the lobbying arm of the church, urged lawmakers to pass Medicaid reform and expansion.

It’s time for senators like Dr. Schaaf and Mr. Lamping to allow their minds the freedom to overcome stubborn loyalty to a political belief that contradicts both their previous votes, and, we hope, their hearts.

Vote no if you must. But stand down from unwise filibuster threats and allow “the least in society” to participate in a health care system that wants to serve them.

Link to original article from The St. Louis Post Dispatch

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